Merli Elena, Romoli Michele, Galluzzo Simone, Zaniboni Anna, Testoni Stefania, Contardi Sara, Cece Emanuele Saverio, Nobili Fabio, Matteo Eleonora, Ricci Gabriele, Simonetti Luigi, Zini Andrea
IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy.
Department of Neurosciences, Bufalini Hospital, AUSL Romagna, Cesena, Italy.
Eur J Neurol. 2025 Feb;32(2):e70043. doi: 10.1111/ene.70043.
To investigate the relevance of hyperperfusion on computerised perfusion imaging (CTP) in the emergency setting in people with non-convulsive status epilepticus (NCSE) and previous stroke, to derive relevant aspects on the epileptogenic focus and the network recruited for NCSE propagation.
We enrolled consecutive adult patients with acute-onset NCSE and a previous stroke at a single institution undergoing CTP and EEG during symptoms. All patients underwent standard imaging including CT, CTP, CT angiograms and standard EEG within 30 min from hospital arrival. Age-/sex-matched NCSE without previous stroke cases and recurrent ischaemic stroke cases were included to test for accuracy of hyperperfusion rates.
Overall, 15 patients had a previous stroke and developed NCSE (mean age 78 years, 46.7% female). All patients had hyperperfusion on CTP imaging (mean onset-to-CTP 184 min). Only one case showed hyperperfusion limited to the previous stroke lesion, and one had a combination of lesional and peri-lesional hyperperfusion. All remaining cases (n = 13) had exclusive extra-lesional involvement. Five cases had multiple separated hyperperfused areas, and five had ipsilateral intra-thalamic hyperperfusion. No correlation emerged between onset-to-CTP timing and hyperperfusion (p value for CTP = 0.66, CBV = 0.28, MTT = 0.28, reverse T = 0.66). Hyperperfusion was present in NCSE cases only and in none of age-/sex-matched ischaemic stroke cases (n = 18).
Hyperperfusion involves cortical areas external to the previous lesion site during NCSE, supporting the relevance of networks for the spatial evolution of epileptic activity and limited relevance of the lesion site for the propagation of the epileptiform activity.
探讨非惊厥性癫痫持续状态（NCSE）且既往有卒中史患者在急诊情况下，计算机断层灌注成像（CTP）上的高灌注相关性，以了解癫痫病灶及NCSE传播所涉及网络的相关情况。
我们纳入了在单一机构就诊的连续成年急性起病NCSE且既往有卒中史的患者，在症状发作时进行CTP和脑电图检查。所有患者在入院后30分钟内接受包括CT、CTP、CT血管造影和标准脑电图在内的标准影像学检查。纳入年龄/性别匹配的无既往卒中史的NCSE病例和复发性缺血性卒中病例，以测试高灌注率的准确性。
总体而言，15例患者既往有卒中史且发生了NCSE（平均年龄78岁，46.7%为女性）。所有患者CTP成像均显示高灌注（平均发病至CTP时间为184分钟）。仅1例显示高灌注局限于既往卒中病灶，1例为病灶及病灶周围高灌注。其余所有病例（n = 13）均为单纯病灶外受累。5例有多个分离的高灌注区域，5例有同侧丘脑内高灌注。发病至CTP时间与高灌注之间无相关性（CTP的p值 = 0.66，CBV = 0.28，MTT = 0.28，反向T = 0.66）。高灌注仅出现在NCSE病例中，年龄/性别匹配的缺血性卒中病例（n = 18）均未出现。
NCSE期间高灌注累及既往病灶部位以外的皮质区域，支持网络对癫痫活动空间演变的相关性以及病灶部位对癫痫样活动传播的相关性有限。
