Abstracts

Rationale: To demonstrate a clinical case showing localized cortical hyperperfusion as a correlate of focal status epilepticus Methods: Clinical case report including EEG documentation, CT-perfusion scan and CT-angiography. Results: A 83-year old man with craniocerebral injury was admitted with the tentative diagnosis of stroke, presenting with right hemiparesis and speech arrest. Morphological CCT revealed microangiopathy and generalized volume-reduction, but no early signs of ischemia or cerebral haemorrhage. CCT perfusion scan did not show the expected localized hypoperfusion. Instead, there was hyperperfusion in the posterior supply area of the left medial cerebral artery (MCA). Several minutes later, the patient developed rhythmic cloni of the right arm and eye deviation to the right. EEG then revealed continuous rhythmic activity in the left posterior region suggesting focal status epilepticus (SE). The status was terminated by i.v. valproate (3000mg per 1 hour). The right hemiparesis (Todd’s paresis) was fully reversible within 2 days. Conclusions: Localized hyperperfusion as detected by CCT perfusion scan in patients with negative neurological symptoms (such as hemiparesis and aphasia) may suggest focal status epilepticus in the absence of positive clinical signs such as clonic or tonic motor activity.