Epileptic Disord. 2022 Jun 1;24(3):549-554. doi: 10.1684/epd.2022.1421.
Objective Among the clinical manifestations of stroke mimics, isolated aphasia is one of the most challenging due to its aetiopathogenic diagnosis. This short communication describes a specific perfusion and brain oscillatory pattern in a challenging case of prolonged isolated aphasia caused by status epilepticus, jointly investigated by computed tomography (CT) perfusion, single-photon emission computerized tomography (SPECT)/CT and EEG qualitative and quantitative analysis. Methods We discuss the different patterns of perfusion neuroimaging and EEG between SE and ischaemic stroke or postictal (Todd's)-related isolated aphasia, and propose these differences as a basis to support the differential diagnosis. Results The pattern associated with SE was characterized by focal hyperperfusion on CT perfusion maps (the left mean transit time was shorter with >10% asymmetry, and left cerebral blood volume and cerebral blood flow increased or slightly altered, relative to the contralateral side) and SPECT (focal left temporal hyperperfusion), without any early ischaemic signs on non-enhanced CT, while the EEG showed a predominant left hemispheric slow delta power. The aforementioned perfusion pattern contrasts with postictal epileptic Todd's phenomenon, which is characterized by hypoperfusion on CT perfusion (the mean transit time is prolonged and cerebral blood volume and cerebral blood flow are reduced, compared to the contralateral hemisphere) and SPECT (focal hypoperfusion), not restricted to the specific vascular territories. Significance CT perfusion patterns may add valuable information to support the differential diagnosis of status epilepticus, rather than acute ischaemic stroke or postictal Todd's phenomenon, in cases with challenging symptoms of prolonged isolated aphasia.
目的 在中风样发作的临床表现中，孤立性失语是最具挑战性的一种，因为其病因诊断较为困难。本短篇通讯描述了一例由癫痫持续状态引起的、持续时间较长的孤立性失语的特殊灌注和脑振荡模式，该病例通过计算机断层扫描（CT）灌注、单光子发射计算机断层扫描（SPECT）/CT 和脑电图定性和定量分析进行了联合研究。方法 我们讨论了 SE 与缺血性中风或癫痫发作后（Todd 氏）相关孤立性失语之间的神经影像学灌注和脑电图的不同模式，并提出这些差异作为支持鉴别诊断的依据。结果 与 SE 相关的模式表现为 CT 灌注图上的局灶性高灌注（左平均通过时间较短，且存在 >10%的不对称性，且与对侧相比，左脑血容量和脑血流增加或略有改变）和 SPECT（左侧颞叶局灶性高灌注），而非增强 CT 上无早期缺血迹象，而脑电图显示以左侧半球为主的慢 delta 功率。上述灌注模式与癫痫发作后的癫痫性 Todd 现象相反，后者的 CT 灌注表现为低灌注（与对侧半球相比，平均通过时间延长，脑血容量和脑血流减少）和 SPECT（局灶性低灌注），且不限于特定的血管区域。意义 CT 灌注模式可为支持鉴别诊断提供有价值的信息，有助于区分癫痫持续状态与急性缺血性中风或癫痫发作后的 Todd 现象，尤其是在具有持续时间较长的孤立性失语等具有挑战性的症状时。
