Epileptic seizures in the emergency room : clinical and electroencephalographic findings associated with brain perfusion patterns on computed tomography
Restrepo, Juan Luis (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Coscojuela, P. (Hospital Universitari Vall d'Hebron)
Fonseca, Elena (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Quintana, Manuel (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Sarria-Estrada, Silvana (Hospital Universitari Vall d'Hebron)
Santamarina, E. (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Abraira del Fresno, Laura (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Sueiras, Maria (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Thonon, Vanessa (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Álvarez Sabín, José (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Toledo, M. (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Rovira, A. (Hospital Universitari Vall d'Hebron)
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	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. 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. 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. 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.
Grants:	Ministerio de Economía, Industria y Competitividad SAF 2016-76648-R
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Computed tomography ; Epilepsy ; Neuroimaging ; Perfusion ; Seizures ; Status epilepticus ; Thalamus
Published in:	Journal of Neurology, february 2022, p. 1-9, ISSN 1432-1459

DOI: 10.1007/s00415-022-11005-1
PMID: 35152335

9 p, 1.2 MB

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