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Updated: Dec 22, 2025
Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
Published on: August 11, 2023
Post-Traumatic Status Epilepticus Masquerading as Acute Ischemic Stroke: A Case Report and Literature Review
Dimitrios Panagopoulos1, Georgios Markogiannakis1, Marios Themistocleous1
1Department of Neurosurgery, Pediatric Hospital of Athens, Agia Sophia, Athens, Greece.
Insights
Advanced imaging, particularly MRI, helps differentiate between seizures and stroke. Post-ictal brain edema, a rare finding, can mimic ischemic stroke but MRI perfusion changes can aid diagnosis.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Advanced imaging is crucial for diagnosing first-time epileptic seizures and suspected ischemic stroke.
- Distinguishing between stroke and seizure-related imaging findings can be challenging.
Abstract:
BACKGROUND Advanced imaging is one of the main modalities utilized in the diagnostic investigation of a first-time epileptic ictus, as well as in the evaluation of a patient suspected of having an ischemic stroke. CASE REPORT We report the case of a 7-year-old boy who was admitted to our hospital because of a depressed skull fracture. Soon after its initial evaluation, he had an episode of generalized tonic-clonic seizures; therefore, a detailed diagnostic work up was scheduled, which raised the diagnostic dilemma of ischemic stroke versus imaging alterations related to status epilepticus. He underwent surgical exploration, and a few days later the repeat MRI verified that the initial signal changes should be attributed to the ictus. CONCLUSIONS Brain edema, most commonly affecting a cerebral hemisphere in its entirety, is a rare post-ictal imaging finding that is causally related to focal-onset status epilepticus. The aforementioned perfusion changes can aid in the differentiation of ictal-related brain abnormalities from acute ischemic stroke, if regional or more diffuse areas of increased perfusion are shown on MRI. Consequently, MRI should be considered the preferred imaging modality when we are confronted with cases of post-ictal signal changes that could masquerade as acute ischemic stroke.
