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Shimoda M, Hoshikawa K, Oda S, Imai M, Osada T, Aoki R, Sunaga A, Shinohara C. Cortical Hyperperfusion on MRI Arterial Spin-Labeling during the Interictal Period of Patients with Migraine Headache. AJNR Am J Neuroradiol 2024; 45:686-692. [PMID: 38663988 PMCID: PMC11288597 DOI: 10.3174/ajnr.a8208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/25/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND AND PURPOSE Concentrations of calcitonin gene-related peptide, a neuropeptide and potent endogenous vasodilator, are reportedly higher in patients with migraine than in healthy subjects, both during and between migraine attacks, reflecting ongoing activation of the trigeminal nervous system. In this prospective study, we measured CBF during the interictal period of patients with migraine after considering insomnia and depression and examined the effects of ongoing activation of the trigeminal nervous system, including during the interictal period, on CBF. MATERIALS AND METHODS In a total of 242 patient with migraine (age range, 18-75 years), CBF was measured by MR imaging arterial spin-labeling during the interictal period and was compared with results from 26 healthy volunteers younger than 45 years of age as control subjects (age range, 22-45 years). Cortical hyperperfusion was defined as identification of ≥2 cerebral cortical regions with regional CBF values at least 2 SDs above the mean regional CBF in control subjects. RESULTS The overall frequency of cortical hyperperfusion was significantly higher in patients with migraine (115 of 242, 48%) than in control subjects (1 of 26, 4%). Multivariable analysis revealed the 18- to 40-year age group and patients with migraine without insomnia as significant positive clinical factors associated with cortical hyperperfusion. Among patients with migraine without insomnia, the frequency of cortical hyperperfusion was >92% (89 of 97). One-way ANOVA showed that in all ROIs of the cortex, regional CBF was significantly higher in patients with migraine without insomnia than in patients with migraine with insomnia or control subjects. In patients with migraine without insomnia, cortical hyperperfusion findings showed a sensitivity of 0.918 and a specificity of 0.962 for migraine in the interictal period, representing excellent accuracy. In contrast, among patients with migraine with insomnia, sensitivity was only 0.179 but specificity was 0.962. CONCLUSIONS Patients with migraine without insomnia may have cortical hyperperfusion during the interictal period; however, the findings of the present study need to be prospectively validated on a larger scale before clinical applicability can be considered.
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Affiliation(s)
- Masami Shimoda
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Kaori Hoshikawa
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Shinri Oda
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Masaaki Imai
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Takahiro Osada
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Rie Aoki
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Azusa Sunaga
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Chiaki Shinohara
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
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Bonduelle T, Ollivier M, Gradel A, Aupy J. Brain MRI in status epilepticus: Relevance of findings. Rev Neurol (Paris) 2024:S0035-3787(24)00423-5. [PMID: 38472033 DOI: 10.1016/j.neurol.2023.12.011] [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: 07/17/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 03/14/2024]
Abstract
Status epilepticus (SE) represents one of the most common neurological emergencies, associated with high mortality and an important risk of functional sequelae in survivors. Magnetic resonance imaging (MRI) offers the possibility of early and noninvasive observation of seizure-induced parenchymal disturbances secondary to the epileptic process. In the present review, we propose a descriptive and comprehensive understanding of current knowledge concerning seizure-induced MRI abnormalities in SE, also called peri-ictal MRI abnormalities (PMAs). We then discuss how PMAs, as a noninvasive biomarker, could be helpful to optimize patient prognostication in SE management. Finally, we discuss alternative promising MRI approaches, including arterial spin labeling (ASL), susceptibility-weighted imaging (SWI), dynamic contrast-enhanced (DCE) MRI and dynamic susceptibility contrast (DSC) MRI that could refine our understanding of SE, particularly in non-convulsive form.
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Affiliation(s)
- T Bonduelle
- Department of Clinical Neurosciences, Epilepsy Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
| | - M Ollivier
- Department of Neuroimaging, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - A Gradel
- Department of Clinical Neurosciences, Epilepsy Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - J Aupy
- Department of Clinical Neurosciences, Epilepsy Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; CNRS, IMN, UMR 5293, Université de Bordeaux, Bordeaux, France
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Tada Y, Fujihara T, Yamaguchi I, Korai M, Sogabe S, Azumi M, Shikata E, Bando K, Nakajima K, Shimada K, Yamamoto N, Yamazaki H, Izumi Y, Harada M, Kanematsu Y, Takagi Y. Nonconvulsive status epilepticus in patients with acute subarachnoid hemorrhage is associated with negative arterial spin labeling on peri-ictal magnetic resonance images. Heliyon 2024; 10:e24754. [PMID: 38298648 PMCID: PMC10828066 DOI: 10.1016/j.heliyon.2024.e24754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 12/16/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024] Open
Abstract
Purpose Non-convulsive status epilepticus (NCSE) is characterized by repetitive or continuous seizures without convulsions. Arterial spin labeling (ASL) is useful for assessing hyperperfusion due to neurovascular unit coupling in patients with NCSE; subarachnoid hemorrhage (SAH) impairs the neurovascular unit. We hypothesized that the sensitivity of ASL in detecting NCSE is low in patients with SAH during the acute phase. Methods Based on ASL findings obtained within 48 h after the clinical suspicion of focal-onset NCSE, we divided 34 patients into ASL-negative (no hyperperfusion; n = 10) and ASL-positive (confirmed hyperperfusion; n = 24) groups. We further divided the two groups according to the NCSE etiology: patients who were diagnosed with NCSE within 14 days after SAH onset (acute SAH, n = 11) and patients with NCSE due to factors other acute SAH (n = 23) and compared their characteristics. Results In 10 of the 34 patients (29.4 %) the ASL findings were normal. The rate of acute SAH was significantly higher in ASL-negative- (n = 8, 80.0 %) than ASL-positive patients (n = 3, 12.5 %). The rate of patients in aphasic status was significantly lower in ASL-negative patients (n = 1, 10 %) than in ASL-positive patients (n = 12, 50.0 %). Conclusion Normal ASL findings alone should not be used to exclude a diagnosis of NCSE particularly in patients in the acute phase of SAH with deterioration or no improvement in consciousness.
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Affiliation(s)
- Yoshiteru Tada
- Epilepsy Center, Tokushima University Hospital, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
- Department of Neurosurgery, Graduate School of Biomedical Sciences, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Toshitaka Fujihara
- Epilepsy Center, Tokushima University Hospital, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
- Department of Neurosurgery, Graduate School of Biomedical Sciences, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Izumi Yamaguchi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Masaaki Korai
- Department of Neurosurgery, Graduate School of Biomedical Sciences, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Shu Sogabe
- Department of Neurosurgery, Graduate School of Biomedical Sciences, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Mai Azumi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Eiji Shikata
- Department of Neurosurgery, Graduate School of Biomedical Sciences, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Koji Bando
- Department of Neurosurgery, Graduate School of Biomedical Sciences, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Kohei Nakajima
- Department of Neurosurgery, Graduate School of Biomedical Sciences, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Kenji Shimada
- Department of Neurosurgery, Graduate School of Biomedical Sciences, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Nobuaki Yamamoto
- Department of Neurology, Graduate School of Biomedical Sciences, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Hiroki Yamazaki
- Epilepsy Center, Tokushima University Hospital, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
- Department of Neurology, Graduate School of Biomedical Sciences, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Yuishin Izumi
- Epilepsy Center, Tokushima University Hospital, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
- Department of Neurology, Graduate School of Biomedical Sciences, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Masafumi Harada
- Department of Radiology, Graduate School of Biomedical Sciences, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Yasuhisa Kanematsu
- Department of Neurosurgery, Graduate School of Biomedical Sciences, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
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Fukuma K, Tojima M, Tanaka T, Kobayashi K, Kajikawa S, Shimotake A, Kamogawa N, Ikeda S, Ishiyama H, Abe S, Morita Y, Nakaoku Y, Ogata S, Nishimura K, Koga M, Toyoda K, Matsumoto R, Takahashi R, Ikeda A, Ihara M. Periodic discharges plus fast activity on electroencephalogram predict worse outcomes in poststroke epilepsy. Epilepsia 2023; 64:3279-3293. [PMID: 37611936 DOI: 10.1111/epi.17760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Postseizure functional decline is a concern in poststroke epilepsy (PSE). However, data on electroencephalogram (EEG) markers associated with functional decline are scarce. Thus, we investigated whether periodic discharges (PDs) and their specific characteristics are associated with functional decline in patients with PSE. METHODS In this observational study, patients admitted with seizures of PSE and who had scalp EEGs were included. The association between the presence or absence of PDs and postseizure short-term functional decline lasting 7 days after admission was investigated. In patients with PD, EEG markers were explored for risk stratification of short-term functional decline, according to the American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology. The association between EEG markers and imaging findings and long-term functional decline at discharge and 6 months after discharge, defined as an increase in the modified Rankin Scale score compared with the baseline, was evaluated. RESULTS In this study, 307 patients with PSE (median age = 75 years, range = 35-97 years, 64% males; hemorrhagic stroke, 47%) were enrolled. Compared with 247 patients without PDs, 60 patients with PDs were more likely to have short-term functional decline (12 [20%] vs. 8 [3.2%], p < .001), with an adjusted odds ratio (OR) of 4.26 (95% confidence interval [CI] = 1.44-12.6, p = .009). Patients with superimposed fast-activity PDs (PDs+F) had significantly more localized (rather than widespread) lesions (87% vs. 58%, p = .003), prolonged hyperperfusion (100% vs. 62%, p = .023), and a significantly higher risk of short-term functional decline than those with PDs without fast activity (adjusted OR = 22.0, 95% CI = 1.87-259.4, p = .014). Six months after discharge, PDs+F were significantly associated with long-term functional decline (adjusted OR = 4.21, 95% CI = 1.27-13.88, p = .018). SIGNIFICANCE In PSE, PDs+F are associated with sustained neuronal excitation and hyperperfusion, which may be a predictor of postseizure short- and long-term functional decline.
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Affiliation(s)
- Kazuki Fukuma
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Maya Tojima
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Katsuya Kobayashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shunsuke Kajikawa
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiro Shimotake
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naruhiko Kamogawa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shuhei Ikeda
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroyuki Ishiyama
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Soichiro Abe
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuriko Nakaoku
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Riki Matsumoto
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders, and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
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5
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Kalchev E. The role of fetal-type posterior cerebral artery in mediating occipital and thalamic perfusion: An arterial spin labeling MRI study. J Med Imaging Radiat Sci 2023; 54:590-594. [PMID: 37718152 DOI: 10.1016/j.jmir.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/31/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND The posterior cerebral artery (PCA) is key in supplying blood to the occipital lobes and significant portions of the thalamus. Some individuals present with a 'fetal-type' posterior cerebral artery (fPCA), which is associated with a higher risk of neurological disorders such as ischemic stroke. This study investigates the relationship between the presence of fPCA and arterial spin labeling (ASL) hyperperfusion patterns in the medial occipital cortex and thalami. METHODS MRI scans from 84 patients with no detectable radiological evidence of brain pathology were retrospectively analyzed. We investigated the association between PCA type (normal vs. fetal) and perfusion pattern (hyperperfused vs. non-hyperperfused) using Fisher's exact test. RESULTS Hyperperfusion in the medial occipital cortex and thalami was absent in all patients with fPCA, but present in 69% of those with normal PCA. In patients with unilateral fPCA, hyperperfusion was exclusively observed on the side with the normal PCA. CONCLUSION The study suggests a consistent relationship between PCA type and ASL perfusion patterns in the medial occipital cortex and thalami. Further research is warranted to explore the physiological underpinnings of these findings and their potential clinical implications. Understanding this relationship could improve the interpretation of ASL MRI and contribute to a better understanding of pathophysiological mechanisms associated with PCA variants.
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Affiliation(s)
- Emilian Kalchev
- Department of Diagnostic Imaging, St Marina University Hospital, Varna, Bulgaria; Department of Diagnostic Imaging, Interventional Radiology and Radiotherapy, Medical University of Varna, Bulgaria.
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Nohara S, Abe G, Ito O, Suzuki S, Morioka T. [Sequential arterial spin labeling findings of status epilepticus showing generalized periodic discharges on EEG following acute infarction in the right occipital lobe]. Rinsho Shinkeigaku 2023; 63:78-84. [PMID: 36725014 DOI: 10.5692/clinicalneurol.cn-001775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In addition to electroencephalogram (EEG), arterial spin labeling (ASL) perfusion images with the dual postlabeling delay (PLD) method are useful for evaluating the hemodynamic state of status epilepticus (SE). A 72-year-old man suffered from an acute infarction in the right occipital lobe, resulting in SE with general periodic discharges on EEG with a higher amplitude on the right side. On ASL, blood flow was increased at a wide area of the right hemisphere centered on this infarct. With improvement of SE, sequential ASL with dual PLD method clearly demonstrated not only the reduction of the signal both in intensity and area but also the decrease of the blood flow velocity.
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Affiliation(s)
- Sohei Nohara
- Department of Neurology, Fukuoka Kieikai Hospital
| | - Gorou Abe
- Department of Neurosurgery, Fukuoka Kieikai Hospital
| | - Osamu Ito
- Department of Neurosurgery, Fukuoka Kieikai Hospital
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7
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Abe K, Shimogawa T, Mukae N, Ikuta K, Shono T, Tanaka A, Sakata A, Shigeto H, Yoshimoto K, Morioka T. Detection of ictal and periictal hyperperfusion with subtraction of ictal-interictal 1.5-Tesla pulsed arterial spin labeling images co-registered to conventional magnetic resonance images (SIACOM). Surg Neurol Int 2023; 14:84. [PMID: 37025532 PMCID: PMC10070274 DOI: 10.25259/sni_723_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/22/2023] [Indexed: 04/08/2023] Open
Abstract
Background Our recent report showed that 1.5-T pulsed arterial spin labeling (ASL) magnetic resonance (MR) perfusion imaging (1.5-T Pulsed ASL [PASL]), which is widely available in the field of neuroemergency, is useful for detecting ictal hyperperfusion. However, the visualization of intravascular ASL signals, namely, arterial transit artifact (ATA), is more remarkable than that of 3-T pseudocontinuous ASL and is easily confused with focal hyperperfusion. To eliminate ATA and enhance the detectability of (peri) ictal hyperperfusion, we developed the subtraction of ictal-interictal 1.5-T PASL images co-registered to conventional MR images (SIACOM). Methods We retrospectively analyzed the SIACOM findings in four patients who underwent ASL during both (peri) ictal and interictal states and examined the detectability for (peri) ictal hyperperfusion. Results In all patients, the ATA of the major arteries was almost eliminated from the subtraction image of the ictal-interictal ASL. In patients 1 and 2 with focal epilepsy, SIACOM revealed a tight anatomical relationship between the epileptogenic lesion and the hyperperfusion area compared with the original ASL image. In patient 3 with situation-related seizures, SIACOM detected minute hyperperfusion at the site coinciding with the abnormal electroencephalogram area. SIACOM of patient 4 with generalized epilepsy diagnosed ATA of the right middle cerebral artery, which was initially thought to be focal hyperperfusion on the original ASL image. Conclusion Although it is necessary to examine several patients, SIACOM can eliminate most of the depiction of ATA and clearly demonstrate the pathophysiology of each epileptic seizure.
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Affiliation(s)
- Keisuke Abe
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan
| | - Takafumi Shimogawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Corresponding author: Takafumi Shimogawa, Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koumei Ikuta
- Department of Radiology, Harasanshin Hospital, Fukuoka, Japan
| | - Tadahisa Shono
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan
| | - Atsuo Tanaka
- Department of Radiology, Harasanshin Hospital, Fukuoka, Japan
| | - Ayumi Sakata
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital, Fukuoka, Japan
- Division of Medical Technology, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Shigeto
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Division of Medical Technology, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takato Morioka
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan
- Department of Neurosurgery, Hachisuga Hospital, Munakata, Japan
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Köstner M, Rebsamen M, Radojewski P, Rummel C, Jin B, Meier R, Ahmadli U, Schindler K, Wiest R. Large-scale transient peri-ictal perfusion magnetic resonance imaging abnormalities detected by quantitative image analysis. Brain Commun 2023; 5:fcad047. [PMID: 36926367 PMCID: PMC10012410 DOI: 10.1093/braincomms/fcad047] [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: 04/10/2022] [Revised: 12/08/2022] [Accepted: 02/23/2023] [Indexed: 02/25/2023] Open
Abstract
Epileptic seizures require a rapid and safe diagnosis to minimize the time from onset to adequate treatment. Some epileptic seizures can be diagnosed clinically with the respective expertise. For more subtle seizures, imaging is mandatory to rule out treatable structural lesions and potentially life-threatening conditions. MRI perfusion abnormalities associated with epileptic seizures have been reported in CT and MRI studies. However, the interpretation of transient peri-ictal MRI abnormalities is routinely based on qualitative visual analysis and therefore reader dependent. In this retrospective study, we investigated the diagnostic yield of visual analysis of perfusion MRI during ictal and postictal states based on comparative expert ratings in 51 patients. We further propose an automated semi-quantitative method for perfusion analysis to determine perfusion abnormalities observed during ictal and postictal MRI using dynamic susceptibility contrast MRI, which we validated on a subcohort of 27 patients. The semi-quantitative method provides a parcellation of 3D T1-weighted images into 32 standardized cortical regions of interests and subcortical grey matter structures based on a recently proposed method, direct cortical thickness estimation using deep learning-based anatomy segmentation and cortex parcellation for brain anatomy segmentation. Standard perfusion maps from a Food and Drug Administration-approved image analysis tool (Olea Sphere 3.0) were co-registered and investigated for region-wise differences between ictal and postictal states. These results were compared against the visual analysis of two readers experienced in functional image analysis in epilepsy. In the ictal group, cortical hyperperfusion was present in 17/18 patients (94% sensitivity), whereas in the postictal cohort, cortical hypoperfusion was present only in 9/33 (27%) patients while 24/33 (73%) showed normal perfusion. The (semi-)quantitative dynamic susceptibility contrast MRI perfusion analysis indicated increased thalamic perfusion in the ictal cohort and hypoperfusion in the postictal cohort. Visual ratings between expert readers performed well on the patient level, but visual rating agreement was low for analysis of subregions of the brain. The asymmetry of the automated image analysis correlated significantly with the visual consensus ratings of both readers. We conclude that expert analysis of dynamic susceptibility contrast MRI effectively discriminates ictal versus postictal perfusion patterns. Automated perfusion evaluation revealed favourable interpretability and correlated well with the classification of the visual ratings. It may therefore be employed for high-throughput, large-scale perfusion analysis in extended cohorts, especially for research questions with limited expert rater capacity.
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Affiliation(s)
- Manuel Köstner
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern University Hospital, Bern CH-3010, Switzerland.,Faculty of Medicine, University of Bern, Bern CH-3008, Switzerland
| | - Michael Rebsamen
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern University Hospital, Bern CH-3010, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern CH-3012, Switzerland
| | - Piotr Radojewski
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern University Hospital, Bern CH-3010, Switzerland.,Translational Imaging Center (TIC), sitem-Insel, Bern University Hospital, Bern CH-3010, Switzerland
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern University Hospital, Bern CH-3010, Switzerland
| | - Baudouin Jin
- Department of Neurology, Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Raphael Meier
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern University Hospital, Bern CH-3010, Switzerland
| | - Uzeyir Ahmadli
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern University Hospital, Bern CH-3010, Switzerland
| | - Kaspar Schindler
- Department of Neurology, Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern University Hospital, Bern CH-3010, Switzerland.,Translational Imaging Center (TIC), sitem-Insel, Bern University Hospital, Bern CH-3010, Switzerland
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9
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Eisermann M, Fillon L, Saitovitch A, Boisgontier J, Vinçon-Leite A, Dangouloff-Ros V, Blauwblomme T, Bourgeois M, Dangles MT, Coste-Zeitoun D, Vignolo-Diard P, Aubart M, Kossorotoff M, Hully M, Losito E, Chemaly N, Zilbovicius M, Desguerre I, Nabbout R, Boddaert N, Kaminska A. Periodic electroencephalographic discharges and epileptic spasms involve cortico-striatal-thalamic loops on Arterial Spin Labeling Magnetic Resonance Imaging. Brain Commun 2022; 4:fcac250. [PMID: 36324869 PMCID: PMC9598541 DOI: 10.1093/braincomms/fcac250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 06/15/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022] Open
Abstract
Periodic discharges are a rare peculiar electroencephalogram pattern, occasionally associated with motor or other clinical manifestations, usually observed in critically ill patients. Their underlying pathophysiology remains poorly understood. Epileptic spasms in clusters and periodic discharges with motor manifestations share similar electroencephalogram pattern and some aetiologies of unfavourable prognosis such as subacute sclerosing panencephalitis or herpes encephalitis. Arterial spin labelling magnetic resonance imaging identifies localizing ictal and inter-ictal changes in neurovascular coupling, therefore assumed able to reveal concerned cerebral structures. Here, we retrospectively analysed ictal and inter-ictal arterial spin labelling magnetic resonance imaging in patients aged 6 months to 15 years (median 3 years 4 months) with periodic discharges including epileptic spasms, and compared these findings with those of patients with drug-resistant focal epilepsy who never presented periodic discharges nor epileptic spasms as well as to those of age-matched healthy controls. Ictal electroencephalogram was recorded either simultaneously with arterial spin labelling magnetic resonance imaging or during the close time lapse of patients' periodic discharges, whereas inter-ictal examinations were performed during the patients' active epilepsy but without seizures during the arterial spin labelling magnetic resonance imaging. Ictal arterial spin labelling magnetic resonance imaging was acquired in five patients with periodic discharges [subacute sclerosing panencephalitis (1), stroke-like events (3), West syndrome with cortical malformation (1), two of them also had inter-ictal arterial spin labelling magnetic resonance imaging]. Inter-ictal group included patients with drug-resistant epileptic spasms of various aetiologies (14) and structural drug-resistant focal epilepsy (8). Cortex, striatum and thalamus were segmented and divided in six functional subregions: prefrontal, motor (rostral, caudal), parietal, occipital and temporal. Rest cerebral blood flow values, absolute and relative to whole brain, were compared with those of age-matched controls for each subregion. Main findings were diffuse striatal as well as cortical motor cerebral blood flow increase during ictal examinations in generalized periodic discharges with motor manifestations (subacute sclerosing panencephalitis) and focal cerebral blood flow increase in corresponding cortical-striatal-thalamic subdivisions in lateralized periodic discharges with or without motor manifestations (stroke-like events and asymmetrical epileptic spasms) with straight topographical correlation with the electroencephalogram focus. For inter-ictal examinations, patients with epileptic spasms disclosed cerebral blood flow changes in corresponding cortical-striatal-thalamic subdivisions (absolute-cerebral blood flow decrease and relative-cerebral blood flow increase), more frequently when compared with the group of drug-resistant focal epilepsies, and not related to Vigabatrin treatment. Our results suggest that corresponding cortical-striatal-thalamic circuits are involved in periodic discharges with and without motor manifestations, including epileptic spasms, opening new insights in their pathophysiology and new therapeutical perspectives. Based on these findings, we propose a model for the generation of periodic discharges and of epileptic spasms combining existing pathophysiological models of cortical-striatal-thalamic network dynamics.
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Affiliation(s)
- Monika Eisermann
- Correspondence to: Monika Eisermann Clinical Neurophysiology, Hôpital Necker Enfants Malades AP-HP, Paris Université, 149 rue de Sèvres75015 Paris, France E-mail:
| | | | - Ana Saitovitch
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, F-75015, Paris, France
- Université de Paris, Institut Imagine INSERM U1163, F-75015, France
- INSERM U1299 Trajectoires développementales & psychiatrie, Paris, France
| | - Jennifer Boisgontier
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, F-75015, Paris, France
- Université de Paris, Institut Imagine INSERM U1163, F-75015, France
- INSERM U1299 Trajectoires développementales & psychiatrie, Paris, France
| | - Alice Vinçon-Leite
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, F-75015, Paris, France
- Université de Paris, Institut Imagine INSERM U1163, F-75015, France
- INSERM U1299 Trajectoires développementales & psychiatrie, Paris, France
| | - Volodia Dangouloff-Ros
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, F-75015, Paris, France
- Université de Paris, Institut Imagine INSERM U1163, F-75015, France
- INSERM U1299 Trajectoires développementales & psychiatrie, Paris, France
| | - Thomas Blauwblomme
- Pediatric Neurosurgery, Hôpital Necker, APHP, Paris France, Université de Paris, Paris, France, INSERM U1163, IHU Imagine, Paris, France
| | - Marie Bourgeois
- Pediatric Neurosurgery, Hôpital Necker, APHP, Paris France, Université de Paris, Paris, France, INSERM U1163, IHU Imagine, Paris, France
| | - Marie-Thérèse Dangles
- Clinical Neurophysiology, Hôpital Necker Enfants Malades, AP-HP, Paris Université, Paris, France
| | - Delphine Coste-Zeitoun
- Clinical Neurophysiology, Hôpital Necker Enfants Malades, AP-HP, Paris Université, Paris, France
| | - Patricia Vignolo-Diard
- Clinical Neurophysiology, Hôpital Necker Enfants Malades, AP-HP, Paris Université, Paris, France
| | - Mélodie Aubart
- Pediatric Neurology Department, Hôpital Necker Enfants Malades, AP-HP, INSERM U1163, Paris Université, Institut Imagine, Paris, France
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, Necker Enfants Malades Hospital, AP-HP, Paris Université, Paris, France
| | - Marie Hully
- Pediatric Neurology Department, Necker Enfants Malades Hospital, AP-HP, Paris Université, Paris, France
| | - Emma Losito
- Clinical Neurophysiology, Hôpital Necker Enfants Malades, AP-HP, Paris Université, Paris, France
| | - Nicole Chemaly
- Reference Center for Rare Epilepsies, Department of Pediatric Neurology, Member of EPICARE Network, Institute Imagine INSERM 1163, Université de Paris, Paris, France
| | - Monica Zilbovicius
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, F-75015, Paris, France
- Université de Paris, Institut Imagine INSERM U1163, F-75015, France
- INSERM U1299 Trajectoires développementales & psychiatrie, Paris, France
| | - Isabelle Desguerre
- Pediatric Neurology Department, Hôpital Necker Enfants Malades, AP-HP, INSERM U1163, Paris Université, Institut Imagine, Paris, France
| | - Rima Nabbout
- Reference Center for Rare Epilepsies, Department of Pediatric Neurology, Member of EPICARE Network, Institute Imagine INSERM 1163, Université de Paris, Paris, France
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Goto K, Shimogawa T, Mukae N, Shono T, Fujiki F, Tanaka A, Sakata A, Shigeto H, Yoshimoto K, Morioka T. Implications and limitations of magnetic resonance perfusion imaging with 1.5-Tesla pulsed arterial spin labeling in detecting ictal hyperperfusion during non-convulsive status epileptics. Surg Neurol Int 2022; 13:147. [PMID: 35509552 PMCID: PMC9062968 DOI: 10.25259/sni_841_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 03/22/2022] [Indexed: 01/23/2023] Open
Abstract
Background:
Recent our reports showed that 3-T pseudocontinuous arterial spin labeling (3-T pCASL) magnetic resonance perfusion imaging with dual post labeling delay (PLD) of 1.5 and 2.5 s clearly demonstrated the hemodynamics of ictal hyperperfusion associated with non-convulsive status epilepticus (NCSE). We aimed to examine the utility of 1.5-T pulsed arterial spin labeling (1.5-T PASL), which is more widely available for daily clinical use, for detecting ictal hyperperfusion.
Methods:
We retrospectively analyzed the findings of 1.5-T PASL with dual PLD of 1.5 s and 2.0 s in six patients and compared the findings with ictal electroencephalographic (EEG) findings.
Results:
In patients 1 and 2, we observed the repeated occurrence of ictal discharges (RID) on EEG. In patient 1, with PLDs of 1.5 s and 2.0 s, ictal ASL hyperperfusion was observed at the site that matched the RID localization. In patient 2, the RID amplitude was extremely low, with no ictal ASL hyperperfusion. In patient 3 with lateralized periodic discharges (LPD), we observed ictal ASL hyperperfusion at the site of maximal LPD amplitude, which was apparent at a PLD of 2.0 s but not 1.5 sec. Among three patients with rhythmic delta activity (RDA) of frequencies <2.5 Hz (Patients 4–6), we observed obvious and slight increases in ASL signals in patients 4 and 5 with NCSE, respectively. However, there was no apparent change in ASL signals in patient 6 with possible NCSE.
Conclusion:
The detection of ictal hyperperfusion on 1.5-T PASL might depend on the electrophysiological intensity of the epileptic ictus, which seemed to be more prominent on 1.5-T PASL than on 3-T pCASL. The 1.5-T PASL with dual PLDs showed the hemodynamics of ictal hyperperfusion in patients with RID and LPD. However, it may not be visualized in patients with extremely low amplitude RID or RDA (frequencies <2.5 Hz).
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Affiliation(s)
| | - Takafumi Shimogawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University,
| | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University,
| | | | | | | | - Ayumi Sakata
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital,
| | - Hiroshi Shigeto
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University,
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11
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Epileptic seizures in the emergency room: clinical and electroencephalographic findings associated with brain perfusion patterns on computed tomography. J Neurol 2022; 269:3761-3769. [PMID: 35152335 PMCID: PMC8852852 DOI: 10.1007/s00415-022-11005-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 12/02/2022]
Abstract
Background Diagnosis of epileptic seizures, particularly regarding status epilepticus (SE), may be challenging in an emergency room setting. The aim of the study was to study the diagnostic yield of perfusion computed tomography (pCT) in patients with single epileptic seizures and SE. Methods We retrospectively reviewed the records of patients who followed an acute ischemic stroke pathway during a 9-month period and who were finally diagnosed with a single epileptic seizure or SE. Perfusion maps were visually analyzed for the presence of hyperperfusion and hypoperfusion. Clinical data, EEG patterns, and neuroimaging findings were compared. Results We included 47 patients: 20 (42.5%) with SE and 27 (57.5%) with single epileptic seizure. Of 18 patients who showed hyperperfusion on pCT, 12 were ultimately diagnosed with SE and eight had EEG findings compatible with an SE pattern. Focal hyperperfusion on pCT had a sensitivity of 60% (95% CI 36.4–80.2) and a specificity of 77.8% (95% CI 57.2–90.6) for predicting a final diagnosis of SE. The presence of cerebral cortical and thalamic hyperperfusion had a high specificity for predicting SE presence. Of note, 96% of patients without hyperperfusion on pCT did not show an SE pattern on early EEG. Conclusions In acute settings, detection by visual analysis of focal cerebral cortical hyperperfusion on pCT in patients with epileptic seizures, especially if accompanied by the highly specific feature of thalamic hyperperfusion, is suggestive of a diagnosis of SE and requires clinical and EEG confirmation. The absence of focal hyperperfusion makes a diagnosis of SE unlikely.
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12
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Dericioglu N, Göçmen R. The value of arterial spin labeling magnetic resonance imaging in the periictal period: A case with continuous lateralized periodic discharges. NEUROL SCI NEUROPHYS 2022. [DOI: 10.4103/nsn.nsn_85_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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13
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Kim TJ, Choi JW, Han M, Kim BG, Park SA, Huh K, Choi JY. Usefulness of arterial spin labeling perfusion as an initial evaluation of status epilepticus. Sci Rep 2021; 11:24218. [PMID: 34930959 PMCID: PMC8688435 DOI: 10.1038/s41598-021-03698-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/06/2021] [Indexed: 11/09/2022] Open
Abstract
This study aimed to evaluate the sensitivity and prognostic value of arterial spin labeling (ASL) in a large group of status epilepticus (SE) patients and compare them with those of other magnetic resonance (MR) sequences, including dynamic susceptibility contrast (DSC) perfusion imaging. We retrospectively collected data of patients with SE in a tertiary center between September 2016 and March 2020. MR images were visually assessed, and the sensitivity for the detection of SE and prognostication was compared among multi-delay ASL, DSC, fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI). We included 51 SE patients and 46 patients with self-limiting seizures for comparison. Relevant changes in ASL were observed in 90.2% (46/51) of SE patients, a percentage higher than those for DSC, FLAIR, and DWI. ASL was the most sensitive method for initial differentiation between SE and self-limiting seizures. The sensitivity of ASL for detecting refractory SE (89.5%) or estimating poor outcomes (100%) was higher than those of other MR protocols or electroencephalography and comparable to those of clinical prognostic scores, although the specificity of ASL was very low as 9.4% and 15.6%, respectively. ASL showed a better ability to detect SE and predict the prognosis than other MR sequences, therefore it can be valuable for the initial evaluation of patients with SE.
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Affiliation(s)
- Tae-Joon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Miran Han
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Byung Gon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea.,Departments of Brain Science and Neurology, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Sun Ah Park
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea.,Department of Anatomy, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kyoon Huh
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea.,Department of Medical Humanities & Social Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jun Young Choi
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea. .,Departments of Brain Science and Neurology, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea.
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14
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Giovannini G, Malagoli M, Turchi G, Miani A, Orlandi N, Vaudano AE, Meletti S. Cortical and thalamic hyper-perfusion in non-convulsive status epilepticus. Relationship between perfusion CT patterns and Salzburg EEG criteria. Seizure 2021; 92:10-17. [PMID: 34391029 DOI: 10.1016/j.seizure.2021.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Status epilepticus (SE) is a neurological emergency and in particular nonconvulsive SE (NCSE) represents a diagnostic challenge. To improve clinical decision-making, cerebral perfusion-computed tomography (PCT) has been shown as a helpful tool to support the diagnosis of focal NCSE. MATERIALS AND METHODS This is a monocentric retrospective study. Among the 602 cases of SE observed between September 2013 and April 2020 we included 21 patients that were studied with PCT. The perfusion maps were first visually analysed then a quantitative analysis (by regions of interest, ROI) was obtained. For each patient, the diagnostic EEG was reviewed and classified in accordance to the Salzburg Criteria for NCSE (SCC) as definite (D-NCSE) and possible (P-NCSE). Finally, we analysed the relationship between PCT and EEG patterns. RESULTS Hyper-perfusion was observed in 18 patients (86%), while in the remaining 3 (14%) a normo-perfused pattern was present. Hyper-perfusion was observed in 14 of the D-NCSE group (88%) and in the two patients with a P-NCSE (100%). No one among the patients with a P-NCSE had a thalamic hyper-perfusion, while among the 6 patients with continuous sustained epileptiform discharges > 2.5 Hz (pattern 1 of SCC), 4 (67%) showed cortical plus thalamic hyper-perfusion. CONCLUSIONS PCT could facilitate the differential diagnosis and speed-up the diagnostic process of NCSE in emergency situations. Finding cortical multi-lobar hyper-perfusion, especially if present together with homolateral thalamic hyper-perfusion in a patient with an acute-onset of motor/sensory/language deficits is highly suggestive for the presence of NCSE and is particularly related to continuous/sustained ictal patterns.
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Affiliation(s)
- Giada Giovannini
- Department of Biomedical, Metabolic, and Neural Science, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, Azienda Ospedaliera Universitaria di Modena, Italy; PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marcella Malagoli
- Neuroradiology Unit, OCB Hospital, Azienda Ospedaliera Universitaria di Modena, Italy
| | - Giulia Turchi
- Neurology Unit, OCB Hospital, Azienda Ospedaliera Universitaria di Modena, Italy
| | - Alice Miani
- Department of Biomedical, Metabolic, and Neural Science, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Orlandi
- Department of Biomedical, Metabolic, and Neural Science, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, Azienda Ospedaliera Universitaria di Modena, Italy
| | | | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Science, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, Azienda Ospedaliera Universitaria di Modena, Italy.
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