Emergency multimodal computed tomography for the diagnosis of stroke mimic--epileptic seizure

@#Background and Objectives: Stroke mimics are medical conditions producing stroke-like symptoms but eventually get diagnosed as non-stroke diseases. Epileptic seizure is a common type of stroke mimic. The purpose of this study is to investigate the application of emergency multimodal computed tomography (CT) in the diagnosis of epileptic seizure. Methods: We retrospectively reviewed the case group of patients with suspected stroke in the emergency stroke care service of the First Affiliated Hospital of Suzhou University from September 2017 to October 2019. We included those who underwent multimodal CT, including non-contrasted cranial CT, CT perfusion with CT angiography, and were ultimately diagnosed as epileptic seizures. Ten patients with acute anterior circulation ischemic stroke were assigned as controls. Results: A total of five cases met the inclusion criteria. Multimodal CT was completed within 2.25 to 3.50h from symptom onset. On CT perfusion, hyperperfusion was shown in four cases and slightly increased perfusion in one case with epileptic seizures. Cerebral blood flow and cerebral blood volume were significantly increased, while time to peak and mean transit time decreased in the regions of interest of the epileptic hemisphere when compared to either the non-affected hemisphere or the ischemic area in the control group (P<0.05). The abnormal perfusion areas did not follow vascular territory supply and CT angiography did not show vessel occlusion in the case group. Conclusion: Emergency multimodal CT could be used effectively to differentiate epileptic seizure from stroke.

Intracranial dural arteriovenous fistula mimicking ischemic stroke and treated with intravenous thrombolysis

@#Stroke patients are evaluated with a non-contrasted brain computed tomography (CT) scan for decision-making for intravenous thrombolysis. We report a case of a patient who presented with receptive aphasia, and was administered IV alteplase after the non-contrasted brain CT showed no contraindication. However, a dural arteriovenous fistula (dAVF) was detected on the subsequent CT angiography performed in the consideration for endovascular therapy. The patient developed fatal symptomatic intra-cerebral hemorrhage, despite subsequent cessation and reversal of thrombolysis. This case highlights how early CT angiography can be useful in hyper-acute stroke patients beyond the detection of large vessel occlusions, with its ability in revealing stroke mimics such as dural arteriovenous fistula and other contraindications to thrombolysis, which may be missed on the noncontrasted brain CT.

Subacute sclerosing panencephalitis: Hyper acute variant

@#Subacute sclerosing panencephalitis (SSPE) usually presents insidiously. Acute presentations with a fulminant course can occur. However hyper acute presentations with a non-progressive course have not been reported. Here we describe two cases that had hyper acute presentation with occipital involvement misdiagnosed initially as ischemic infarct. One case remained stable for 4 years and then had a fulminant course and patient succumbed; the other patient continued to remain stable at 2 year follow up. In countries where SSPE is prevalent, it is important to be aware of such a variant of SSPE.

Clinical characteristics and differentiation of stroke mimics during super early intravenous thrombolysis of acute ischemic stroke / 第二军医大学学报

Objective To study the clinical characteristics and differentiation of stroke mimics during super early intravenous thrombolysis of acute ischemic stroke. Methods The clinical data of patients who received intravenous thrombolysis between Sep. 2013 and Feb. 2015 in Changhai Hospital were retrospectively analyzed. And those with stroke mimics were identified and were compared with those with strokes; the clinical symptoms and laboratory findings were compared between the two groups. Results A total of 212 patients received intravenous thrombolysis, and 7(3. 3%) of them were identified as having stroke mimics. There were no notable differences in the baseline characteristics between mimics and stroke groups. Psychiatric and dementia history were of great value for differentiation of stroke mimics from strokes. MRI, vascular assessment, electroencephalogram (EEG), blood and cerebrospinal fluid assay greatly contributed to the final diagnosis of stroke mimics. Conclusion Only few patients receiving intravenous thrombolysis have been confirmed to have stroke mimics. Medical history combined with MRI may be of great value for differentiation of mimics and strokes.