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Various pathophysiological states of acute symptomatic seizures immediately after ischemic stroke, namely “onset seizures,” shown by complementary use of peri‐ictal magnetic resonance imaging and electroencephalography
Author(s) -
Murao Kei,
Morioka Takato,
Shimogawa Takafumi,
Furuta Yoshihiko,
Haga Sei,
Sakata Ayumi,
Arihiro Shoji,
Arakawa Shuji
Publication year - 2017
Publication title -
neurology and clinical neuroscience
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.125
0ISSN - 2049-4173
DOI - 10.1111/ncn3.12160
Subject(s) - ictal , medicine , magnetic resonance imaging , electroencephalography , hyperintensity , status epilepticus , epilepsy , infarction , stroke (engine) , cardiology , anesthesia , diffusion mri , radiology , myocardial infarction , psychiatry , mechanical engineering , engineering
Background “Onset seizures” are acute symptomatic seizures occurring within 24 h after the onset of ischemic stroke, and their pathophysiological states are unknown. Electroencephalography is commonly used to diagnose epileptic activities; however, it is limited for use with acute stroke. Magnetic resonance imaging, including diffusion‐weighted imaging and perfusion imaging with arterial spin labeling, are applied mainly in an emergency. Ictal hyperperfusion on arterial spin labeling and cortical hyperintensity of cytotoxic edema on diffusion‐weighted imaging, peri‐ictally, can be obtained from an epileptically activated cortex. Aim We aimed to show pathophysiological states of onset seizures by complementary use of peri‐ictal magnetic resonance imaging and electroencephalography. Methods Four patients diagnosed as onset seizures underwent an initial magnetic resonance imaging and subsequent electroencephalography. Results In case 1, having persistent non‐convulsive status epilepticus after control of onset seizures, ictal magnetic resonance imaging and electroencephalography findings clearly showed the topographical relationship between the acute atherothrombotic infarction and the peri‐infarction activated cortex. In case 2, with multiple embolic strokes in the bifrontal lobes, prolonged arterial spin labeling hyper signals were observed in the perirolandic area of the right leg; cortical hyperintensity on diffusion‐weighted imaging and paroxysmal activities on electroencephalography were not shown. In cases 3 and 4, postictal hypoperfusion was shown in the large extent involving the multiple embolic infarctions. Because the epileptic cortex was located in the convexity, electroencephalography clearly showed inter‐ictal paroxysms in case 3, and localized slow wave in case 4. Conclusion The present study shows that the complementary use of peri‐ictal arterial spin labeling/diffusion‐weighted imaging and electroencephalography potentially offers the ability to document the various pathophysiological states of onset seizure.