Utility of CT perfusion in seizures and rhythmic and periodic patterns

IF 3.7 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology Pub Date : 2024-10-20 DOI:10.1016/j.clinph.2024.10.008

Syed Ameen Ahmad , Christopher Primiani , Michael Porambo , Tran Dang , Peter W. Kaplan , Vivek Yedavalli , Khalil S. Husari

{"title":"Utility of CT perfusion in seizures and rhythmic and periodic patterns","authors":"Syed Ameen Ahmad , Christopher Primiani , Michael Porambo , Tran Dang , Peter W. Kaplan , Vivek Yedavalli , Khalil S. Husari","doi":"10.1016/j.clinph.2024.10.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>CT hyper-perfusion has been reported in non-convulsive status epilepticus (NCSE), while its occurrence and relevance after single seizures or with rhythmic and periodic patterns (RPPs) that lie along the ictal-interictal continuum (IIC), remain unclear. The goal of the study is to assess the role of CT perfusion (CTP) in diagnosing patients with clinical seizures, subclinical seizures, or RPPs that lie along the IIC, to help in the clinical assessment of these entities.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed inpatients who underwent a CTP and an EEG within 6 h of each other. CTP and EEGs were blindly reviewed independent of electronic medical records.</div></div><div><h3>Results</h3><div>Out of 103 patients, 15 patients (15 %) demonstrated hyper-perfusion, 40 patients (39 %) had hypo-perfusion, while 48 patients (47 %) had normal CTP. Patients with focal CTP hyperperfusion were more likely to have clinical seizures, electrographic seizures, and/or lateralized rhythmic periodic patterns (RPPs) compared to those without CTP hyperperfusion<strong>.</strong> Focal CTP hyper-perfusion had 34 % sensitivity and 96 % specificity for identifying patients with clinical seizures, and a 40 % sensitivity and 92 % specificity for identifying patients with electrographic seizures or lateralized RPP. Although the numbers were small, none of the patients with generalized periodic discharges or generalized rhythmic delta activity had CTP hyper-perfusion.</div></div><div><h3>Conclusions</h3><div>Focal CTP hyper-perfusion has low sensitivity but high specificity for identifying patients with seizures and lateralized RPPs, and may be considered in the clinical assessment of patients where the clinical information are unclear or insufficient.</div></div><div><h3>Significance</h3><div>The presence of CTP hyper-perfusion should alert the physician to the possibility of an ictal related etiology accounting for the patient’s symptoms.</div></div>","PeriodicalId":10671,"journal":{"name":"Clinical Neurophysiology","volume":"168 ","pages":"Pages 121-128"},"PeriodicalIF":3.7000,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Neurophysiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1388245724003134","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

CT hyper-perfusion has been reported in non-convulsive status epilepticus (NCSE), while its occurrence and relevance after single seizures or with rhythmic and periodic patterns (RPPs) that lie along the ictal-interictal continuum (IIC), remain unclear. The goal of the study is to assess the role of CT perfusion (CTP) in diagnosing patients with clinical seizures, subclinical seizures, or RPPs that lie along the IIC, to help in the clinical assessment of these entities.

Methods

We retrospectively reviewed inpatients who underwent a CTP and an EEG within 6 h of each other. CTP and EEGs were blindly reviewed independent of electronic medical records.

Results

Out of 103 patients, 15 patients (15 %) demonstrated hyper-perfusion, 40 patients (39 %) had hypo-perfusion, while 48 patients (47 %) had normal CTP. Patients with focal CTP hyperperfusion were more likely to have clinical seizures, electrographic seizures, and/or lateralized rhythmic periodic patterns (RPPs) compared to those without CTP hyperperfusion. Focal CTP hyper-perfusion had 34 % sensitivity and 96 % specificity for identifying patients with clinical seizures, and a 40 % sensitivity and 92 % specificity for identifying patients with electrographic seizures or lateralized RPP. Although the numbers were small, none of the patients with generalized periodic discharges or generalized rhythmic delta activity had CTP hyper-perfusion.

Conclusions

Focal CTP hyper-perfusion has low sensitivity but high specificity for identifying patients with seizures and lateralized RPPs, and may be considered in the clinical assessment of patients where the clinical information are unclear or insufficient.

Significance

The presence of CTP hyper-perfusion should alert the physician to the possibility of an ictal related etiology accounting for the patient’s symptoms.

查看原文本刊更多论文

CT 灌注在癫痫发作以及节律性和周期性模式中的应用。

目的：CT 高灌注在非惊厥性癫痫状态（NCSE）中已有报道，但其在单次癫痫发作后或沿发作-发作间期连续体（IIC）的节律性和周期性模式（RPPs）中的发生和相关性仍不清楚。本研究的目的是评估 CT 灌注（CTP）在诊断临床癫痫发作、亚临床癫痫发作或位于 IIC 沿线的节律性和周期性模式（RPPs）患者中的作用，以帮助对这些实体进行临床评估：我们对在 6 小时内接受过 CTP 和脑电图检查的住院患者进行了回顾性分析。结果：在 103 名患者中，有 15 名患者（15%）在接受 CTP 和脑电图检查后，出现了颅内压增高：在 103 名患者中，15 名患者（15%）表现为高灌注，40 名患者（39%）表现为低灌注，而 48 名患者（47%）CTP 正常。与无 CTP 过度灌注的患者相比，有局灶性 CTP 过度灌注的患者更有可能出现临床癫痫发作、电图癫痫发作和/或侧向节律性周期模式 (RPP)。灶性 CTP 过度灌注对鉴别临床癫痫发作患者的敏感性为 34%，特异性为 96%；对鉴别电图癫痫发作或侧位化 RPP 患者的敏感性为 40%，特异性为 92%。虽然人数不多，但全身周期性放电或全身节律性三角活动患者中没有一人出现 CTP 过度灌注：结论：局灶性 CTP 高灌注对识别癫痫发作和侧向 RPP 患者的敏感性较低，但特异性较高，在临床信息不明确或不充分的患者的临床评估中可予以考虑：意义：CTP 高灌注的出现应提醒医生注意患者症状可能与发作相关的病因。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Neurophysiology 医学-临床神经学

CiteScore

8.70

自引率

6.40%

发文量

932

审稿时长

59 days

期刊介绍： As of January 1999, The journal Electroencephalography and Clinical Neurophysiology, and its two sections Electromyography and Motor Control and Evoked Potentials have amalgamated to become this journal - Clinical Neurophysiology. Clinical Neurophysiology is the official journal of the International Federation of Clinical Neurophysiology, the Brazilian Society of Clinical Neurophysiology, the Czech Society of Clinical Neurophysiology, the Italian Clinical Neurophysiology Society and the International Society of Intraoperative Neurophysiology.The journal is dedicated to fostering research and disseminating information on all aspects of both normal and abnormal functioning of the nervous system. The key aim of the publication is to disseminate scholarly reports on the pathophysiology underlying diseases of the central and peripheral nervous system of human patients. Clinical trials that use neurophysiological measures to document change are encouraged, as are manuscripts reporting data on integrated neuroimaging of central nervous function including, but not limited to, functional MRI, MEG, EEG, PET and other neuroimaging modalities.