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Cheval M, Hingray C, Kanemoto K, de Toffol B, Tarrada A. Insights into Postictal Psychosis, from functional imaging and EEG: A systematic review. Seizure 2024; 121:45-55. [PMID: 39074414 DOI: 10.1016/j.seizure.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/27/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
Multiple hypotheses exist about the pathophysiology of Postictal Psychosis (PIP). As the clinical manifestations of PIP are roughly stereotyped, we assumed the existence of a common neurological pathway. This study aimed to determine if a specific brain network sustained the psychotic episode, regardless of the localization of the epileptogenic zone. We conducted a systematic review following the PRISMA guidelines. We included a total of 24 studies providing electrophysiological results(n=22) and metabolic imaging performed during the PIP(n=5). Temporal and frontal lobes seemed frequently involved, without clear evidence for lateralization. The EEG patterns were heterogenous, varying from unchanged to diffuse slowing. Metabolic pattern showed an increased perfusion within temporal and frontal lobes during PIP. These results correspond to the patterns described during postictal state, but they persisted throughout PIP, within regions larger than the epileptogenic zone and resolved with the recovery. PIP symptoms are associated with an excessive persistence of postictal changes within extended frontotemporal networks. A hypothesis could be that PIP results from an abnormally prolonged and diffuse post-ictal dysregulation.
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Affiliation(s)
- Margaux Cheval
- EEG-monitoring Unit, Neurology Department, Hôpital Central, CHU de Nancy, 54000 Nancy, France; Epileptology Unit, Reference Center for Rare Epilepsies, Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.; Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Coraline Hingray
- EEG-monitoring Unit, Neurology Department, Hôpital Central, CHU de Nancy, 54000 Nancy, France; Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, 54000 Laxou, France
| | - Kousuke Kanemoto
- Department of Neuropsychiatry, Aichi Medical University, Nagoya, Japan
| | - Bertrand de Toffol
- UMR 1253, iBrain, Université de Tours, Inserm, France; Neurology and Neurophysiology Unit, Centre Hospitalier de Cayenne, France & CIC INSERM 1424
| | - Alexis Tarrada
- EEG-monitoring Unit, Neurology Department, Hôpital Central, CHU de Nancy, 54000 Nancy, France; Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, 54000 Laxou, France..
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Tanaskovic S, Cimbaljevic N, Petrovic J, Ljatifi E, Antonijevic M, Neskovic M, Ostojic A, Ilijevski N. Todd's paralysis due to hyperperfusion syndrome after carotid endarterectomy mimicking postoperative stroke. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:521-525. [PMID: 37335281 DOI: 10.23736/s0021-9509.23.12720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Todd's paralysis is a neurological deficit that is observed in <10% of patients following epileptic seizures. Cerebral hyperperfusion syndrome (CHS) is a rare complication following carotid endarterectomy (CEA), seen in 0-3% of the patients, characterized by focal neurological deficit, headache, disorientation, and sometimes seizures. In this case report, we present a case of CHS after CEA followed by seizures and Todd's paralysis that mimicked postoperative stroke. A 75-year-old female patient was admitted for CEA of the right internal carotid artery, following a transient ischemic attack two months prior. Four hours after CEA with graft interposition, the patient suffered a temporary weakness of the left arm and leg followed by generalized spasms within a few seconds. CT angiography showed regular patency of the carotid arteries and the graft, and brain CT showed no sign of oedema, ischemia or hemorrhage. However, left-sided hemiplegia occurred following the seizure, and the patient suffered four more seizures over the next 48 hours, with persisting hemiplegia. On the second postoperative day, the motor skills of the left side fully recovered, and the patient was communicative, and of orderly mental status. Brain CT performed on the third postoperative day showed entire right hemisphere oedema. A moderate hemiparesis with seizures as a consequence of CHS after CEA has been described, however in all cases with seizures and hemiplegia, the underlying cause was always a verified stroke or intracerebral hemorrhage. This case highlights the importance of considering Todd's paralysis in patients with seizures after CEA due to CHS and prolonged periods of hemiplegia after the seizures.
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Affiliation(s)
- Slobodan Tanaskovic
- Vascular Surgery Clinic, Dedinje Institute for Cardiovascular Diseases, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Cimbaljevic
- Vascular Surgery Clinic, Dedinje Institute for Cardiovascular Diseases, Belgrade, Serbia
| | - Jovan Petrovic
- Vascular Surgery Clinic, Dedinje Institute for Cardiovascular Diseases, Belgrade, Serbia -
| | - Enes Ljatifi
- Vascular Surgery Clinic, Dedinje Institute for Cardiovascular Diseases, Belgrade, Serbia
| | - Mirjana Antonijevic
- Department of Neuroangiology, Vascular Surgery Clinic, Dedinje Institute for Cardiovascular Diseases, Belgrade, Serbia
| | - Maja Neskovic
- Department of Neuroangiology, Vascular Surgery Clinic, Dedinje Institute for Cardiovascular Diseases, Belgrade, Serbia
| | - Aleksandra Ostojic
- Department of Non-Invasive Radiological Diagnostics, Dedinje Institute for Cardiovascular Diseases, Belgrade, Serbia
| | - Nenad Ilijevski
- Vascular Surgery Clinic, Dedinje Institute for Cardiovascular Diseases, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Ahmed A, Hamam O, Niri SG, Oeltzchner G, Garg T, Elmandouh O, Intrapiromkul J, Yedavalli V. Computed tomography perfusion stroke mimics on RAPID commercial software: A case-based review. Brain Circ 2023; 9:68-76. [PMID: 37576575 PMCID: PMC10419735 DOI: 10.4103/bc.bc_100_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/17/2023] [Accepted: 03/01/2023] [Indexed: 08/15/2023] Open
Abstract
Acute ischemic stroke (AIS) is a leading cause of morbidity worldwide and can present with nonspecific symptoms, making diagnosis difficult. Many neurologic diseases present similarly to stroke; stroke mimics account for up to half of all hospital admissions for stroke. Stroke therapies carry risk, so accurate diagnosis of AIS is crucial for prompt treatment and prevention of adverse outcomes for patients with stroke mimics. Computed tomography (CT) perfusion techniques have been used to distinguish between nonviable tissue and penumbra. RAPID is an operator-independent, automated CT perfusion imaging software that can aid clinicians in diagnosing strokes quickly and accurately. In this case-based review, we demonstrate the applications of RAPID in differentiating between strokes and stroke mimics.
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Affiliation(s)
- Amara Ahmed
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Omar Hamam
- Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Tushar Garg
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Omar Elmandouh
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Pottkämper JCM, Hofmeijer J, van Waarde JA, van Putten MJAM. The postictal state - What do we know? Epilepsia 2020; 61:1045-1061. [PMID: 32396219 PMCID: PMC7317965 DOI: 10.1111/epi.16519] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
This narrative review provides a broad and comprehensive overview of the most important discoveries on the postictal state over the past decades as well as recent developments. After a description and definition of the postictal state, we discuss postictal sypmtoms, their clinical manifestations, and related findings. Moreover, pathophysiological advances are reviewed, followed by current treatment options.
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Affiliation(s)
- Julia C M Pottkämper
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jeannette Hofmeijer
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Michel J A M van Putten
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
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