Abstract Details

Title Efficacy of CT-Perfusion Study in Differentiating Seizures from Acute Stroke Prior to Initiating Tissue Plasminogen Activator Therapy

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P02 - (-)

Poster/Presentation
Number 033

Objective

Background BACKGROUND: Studies show that 20% of patients who receive TPA are stroke mimics. Seizures can mimic strokes and are contraindicated in TPA therapy. While performing an EEG is time consuming, CT-Perfusion studies are readily done for acute strokes and can be a tool for differentiating acute ischemic events from seizures, as our study demonstrates. On perfusion studies, ischemic strokes are associated with decreased blood flow whereas seziures are associated with an increased flow to the affected area.

Design/Methods DESIGN/METHODS: 75 year old male with past history of hypertension and hyperlipidemia presented to the Emergency Room with gaze deviation, right-sided weakness and speech difficulty with no witnessed seizures. Time of onset was greater than 3 hours prior to presentation and NIHSS was 12. CT scan of the head did not show any acute changes. CT-Perfusion study performed showed hyperperfusion in the left parietoccipital region with no ischemia noted. Upon returning from CT scan patient developed a witnessed seizure and was treated with intravenous Keppra and Vimpat. EEG performed later showed left-sided spike activity. Magenetic Resonance Imaging of head showed old encephalomalacia in left occipital lobe. Thereafter the patient had resolution of hemiparesis and speech.

Results RESULTS: Our study demonstrated that CT-Perfusion scans are helpful in differentiating seizures from acute strokes based upon the patterns of blood flow. EEG later confirmed seziure activity.

Conclusions CONCLUSIONS: CT-Perfusion studies exhibit increased cerebral blood flow in seizures in constrast to decreased blood flow in ischemic events. It can help differentiate an acute stroke from an ictal discharge and can assist in preventing improper use of TPA and hemorrhagic complications.

Authors/Disclosures
Iftekhar Ahmed, MD, PC, FAAN (HCA) PRESENTER	Dr. Ahmed has nothing to disclose.
	No disclosure on file
	No disclosure on file
Steven C. Kosa, MD, FAAN (Meritas Health Neurology)	Dr. Kosa has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for AbbVie. Dr. Kosa has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Eli Lily . Dr. Kosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Impel. Dr. Kosa has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biohaven/Pfizer. Dr. Kosa has received research support from Eli Lily .
Joseph H. Friedman, MD, FAAN (Butler Hospital)	No disclosure on file
Gavin Giovannoni, MD (QMUL)	Dr. Giovannoni has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Merck KGaA. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche-Genentech. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Moderna. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sandoz. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Astoria Biologica. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Zenas. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Giovannoni has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Medscape.

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