Department of Neurosurgery, Pediatric Hospital of Athens, Agia Sophia, Athens, Greece.
Am J Case Rep. 2020 May 4;21:e922679. doi: 10.12659/AJCR.922679.
BACKGROUND Advanced imaging is one of the main modalities utilized in the diagnostic investigation of a first-time epileptic ictus, as well as in the evaluation of a patient suspected of having an ischemic stroke. CASE REPORT We report the case of a 7-year-old boy who was admitted to our hospital because of a depressed skull fracture. Soon after its initial evaluation, he had an episode of generalized tonic-clonic seizures; therefore, a detailed diagnostic work up was scheduled, which raised the diagnostic dilemma of ischemic stroke versus imaging alterations related to status epilepticus. He underwent surgical exploration, and a few days later the repeat MRI verified that the initial signal changes should be attributed to the ictus. CONCLUSIONS Brain edema, most commonly affecting a cerebral hemisphere in its entirety, is a rare post-ictal imaging finding that is causally related to focal-onset status epilepticus. The aforementioned perfusion changes can aid in the differentiation of ictal-related brain abnormalities from acute ischemic stroke, if regional or more diffuse areas of increased perfusion are shown on MRI. Consequently, MRI should be considered the preferred imaging modality when we are confronted with cases of post-ictal signal changes that could masquerade as acute ischemic stroke.
高级影像学是首次癫痫发作和疑似缺血性脑卒中患者诊断评估的主要方法之一。
我们报告了一例 7 岁男孩的病例，因颅骨凹陷性骨折而入院。在初始评估后不久，他出现了全身性强直阵挛性发作；因此，进行了详细的诊断检查，这提出了缺血性脑卒中与癫痫持续状态相关影像学改变之间的诊断难题。他接受了手术探查，几天后重复 MRI 证实了初始信号改变应归因于癫痫发作。
脑水肿最常见于整个大脑半球，是一种罕见的癫痫发作后影像学表现，与局灶性起始性癫痫持续状态有因果关系。如果 MRI 显示局部或更广泛区域的灌注增加，则上述灌注变化有助于区分与癫痫发作相关的脑异常与急性缺血性脑卒中。因此，当我们遇到可能表现为急性缺血性脑卒中的癫痫发作后信号改变时，MRI 应被视为首选的影像学检查方法。
