Nonconvulsive Partial Status Epilepticus Mimicking Recurrent Infarction Revealed by Diffusion-weighted and Arterial Spin Labeling Perfusion Magnetic Resonance Images

• Published in: Journal of stroke and cerebrovascular diseases Vol. 24; no. 4; pp. 731 - 738
• Main Authors: Kanazawa, Yuka, MD, Morioka, Takato, MD, PhD, Arakawa, Shuji, MD, PhD, Furuta, Yoshihiko, MD, Nakanishi, Asako, MD, Kitazono, Takanari, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2015
• Subjects: Aged; arterial spin labeling; Brain Infarction - physiopathology; Cardiovascular; diffusion-weighted image; Electroencephalography; Female; Humans; ictal hyperperfusion; Image Processing, Computer-Assisted; Magnetic Resonance Angiography; Neurology; nonconvulsive status epilepticus; Spin Labels; Status Epilepticus - diagnosis; Stroke mimics; diffusion-weighted image; ictal hyperperfusion; nonconvulsive status epilepticus; Stroke mimics; arterial spin labeling
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2014.09.026

“Non-convulsive” partial status epilepticus (SE) is an important pathologic condition that should be differentiated from cerebral infarction. Herein, we reported 2 patients who had partial SE associated with old infarction in the right parietal lobe. Each patient had 2 episodes of left hemiparesis and hemisensory disturbance without convulsion. On diffusion-weighted magnetic resonance images (DW-MRI), a hyperintense lesion was noted in the cortex around the old infarction lesion, and recurrent infarction was suspected. Although electroencephalography (EEG) failed to reveal ictal discharges or interictal paroxysmal activities in 3 of 4 episodes, perfusion images with arterial spin labeling (ASL) clearly demonstrated ictal hyperperfusion in the area corresponding to the cortical hyperintense lesion on DW-MRI. After appropriate anticonvulsant treatment based on the diagnosis of partial SE, clinical symptoms were completely improved. These data stress the importance of cortical hyperintensity on DW-MRI and ictal ASL hyperperfusion, even when SE cannot be determined from EEG.