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Using CT Perfusion in the Interictal State.

Irfan S Sheikh¹, Sihyeong Park, Imran Ali

¹Department of Neurology, University of Toledo Neurology, ProMedica Neuroscience Center, Toledo, Ohio, U.S.A.

Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society

|November 8, 2021

Summary

This summary is machine-generated.

Lateralized periodic discharges on continuous electroencephalography (EEG) can indicate seizures. Computed tomography perfusion scans showing hyperemia may help diagnose subclinical seizures when other imaging is unavailable.

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Area of Science:

Neurology
Neurophysiology
Neuroradiology

Background:

Continuous electroencephalography (EEG) monitoring is crucial for patients with altered mental status and potential seizure activity.
Differentiating between interictal and ictal patterns on EEG can be challenging, especially in sedated patients.

Observation:

An 83-year-old male with acute subdural hematoma developed intermittent neurological deficits post-craniotomy.
Continuous EEG revealed lateralized periodic discharges.
A computed tomography (CT) perfusion study demonstrated left hemispheric hyperemia, suggesting an ictal phenomenon.

Findings:

The CT perfusion findings of hyperemia correlated with ongoing subclinical seizure activity.
Aggressive adjustment of anti-seizure medication based on CT perfusion results led to clinical and EEG improvement.

Implications:

CT perfusion may serve as a valuable diagnostic tool to identify subclinical ictal activity when advanced imaging like PET or SPECT is not feasible.
This approach can guide more effective antiepileptic treatment strategies in challenging neurological cases.