Status epilepticus, hemispheric confusion, a CT perfusion pitfall in “code stroke” patients: A case report

Abstract

CT perfusion (CTP) is an evolving protocol for stroke evaluation in many hospitals, but there are several pitfalls in CT perfusion. Herein I present a patient suspicious of brain infarction under “stroke code”. CT perfusion was initially visually interpreted and because of obvious asymmetry between the right and left cerebral hemispheres the interpretation was consistent with right cerebral ischemia. CT angiogram (CTA) did not demonstrate significant vascular stenosis. Subsequent electroencephalography (EEG) was consistent with status epilepticus from the left cerebral hemisphere. Since more and more CTPs are now performed in acute setting of code stroke more patients are being imaged with ongoing seizure with increased perfusion in epileptogenic brain parenchyma. This is different from the conventional concept of hypo perfusion of the involved brain in CTP performed in the “post-ictal” phase. The interpreting radiologist should be informed about the patient symptoms and should avoid solo visual assessment of CT perfusion in patients under the “stroke code”.