Can perfusion CT unmask postictal stroke mimics? A case-control study of 133 patients

OBJECTIVE: To study the diagnostic value of volume perfusion CT (VPCT) in patients with transient focal neurological deficits following and during epileptic seizures, that mimic symptoms of stroke.
METHODS: a retrospective case-control study was performed on 159 patients that presented with a seizure and received an emergency VPCT within the first 3.5 hours of admission, after being misjudged to have an acute stroke. The reference test was a clinical-based, EEG-supported diagnostic algorithm for seizure.
RESULTS: We included 133 patients: 94 stroke-mimicking cases with postictal focal neurological deficits (“Todd’s phenomenon”, n=67) or ongoing seizure on hospital admission (“ictal patients”, n=27), and 39 postictal controls without focal neurological deficits. Patients with Todd’s phenomenon showed normal (64%), hypo (21%)- and hyperperfusion (14%) on early VPCT. Ictal patients displayed more hyperperfusion compared to postictal patients (p=0.015). Test sensitivity of hyperperfusion ...