External carotid artery and salivary glands- potential indicators of seizure laterality

Seizure is one of the most common stroke mimics occurring in patients referred to stroke services. Asymmetric enlargement of External Carotid Artery (ECA) branches and asymmetric enhancement of parotid and submandibular salivary glands seen on Computerized Tomography Angiography of the head and neck done for stroke evaluation are two imaging signs which may potentially help to differentiate seizure from stroke as well as point to the seizure laterality. In this case series, we describe five cases demonstrating these imaging findings in patients with suspected acute stroke who had CTA head and neck for stroke workup, with subsequent MRI and Electroencephalogram (EEG) correlates. Potential mechanism is parasympathetic stimulation.