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CT perfusion: stroke, seizure or both?

An 88-year-old male with a history of hypertension, ischaemic heart disease and Bell’s palsy presented with symptoms and signs of an acute ischaemic stroke. National Institutes of Health Stroke Scale (NIHSS) was 19 at presentation, indicative of potential large vessel occlusion. The initial CT scan...

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Autores principales: Davis, Elizabeth, Elnagi, Fathalla, Smith, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8719119/
https://www.ncbi.nlm.nih.gov/pubmed/34969793
http://dx.doi.org/10.1136/bcr-2021-245723
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author Davis, Elizabeth
Elnagi, Fathalla
Smith, Thomas
author_facet Davis, Elizabeth
Elnagi, Fathalla
Smith, Thomas
author_sort Davis, Elizabeth
collection PubMed
description An 88-year-old male with a history of hypertension, ischaemic heart disease and Bell’s palsy presented with symptoms and signs of an acute ischaemic stroke. National Institutes of Health Stroke Scale (NIHSS) was 19 at presentation, indicative of potential large vessel occlusion. The initial CT scan revealed evidence of small vessel disease and arterial calcification. As there were no contraindications, he received thrombolytic treatment. CT angiography and CT perfusion imaging were performed in preparation for possible thrombectomy. There was no evidence of a large vessel thrombus, and changes on CT perfusion were suggestive of seizure activity, with relative hyperperfusion on the cerebral hemisphere of interest. Post thrombolysis, his NIHSS was 5. An MR scan revealed evidence of bilateral thalamic infarcts. After a period of rehabilitation, he was discharged home and independently mobile but with cognitive impairment. Acute stroke care increasingly uses multimodal imaging to confirm the clinical diagnosis and help optimise initial emergency management. Such imaging is useful in determining whether the presentation is a vascular event or stroke mimic. Moreover, seizures complicate and mimic acute strokes, which can lead to therapeutic uncertainty. This case highlights the increasingly sophisticated investigation of patients presenting with suspected acute stroke, with the attendant need for accurate interpretation by experienced clinicians.
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spelling pubmed-87191192022-01-12 CT perfusion: stroke, seizure or both? Davis, Elizabeth Elnagi, Fathalla Smith, Thomas BMJ Case Rep Case Report An 88-year-old male with a history of hypertension, ischaemic heart disease and Bell’s palsy presented with symptoms and signs of an acute ischaemic stroke. National Institutes of Health Stroke Scale (NIHSS) was 19 at presentation, indicative of potential large vessel occlusion. The initial CT scan revealed evidence of small vessel disease and arterial calcification. As there were no contraindications, he received thrombolytic treatment. CT angiography and CT perfusion imaging were performed in preparation for possible thrombectomy. There was no evidence of a large vessel thrombus, and changes on CT perfusion were suggestive of seizure activity, with relative hyperperfusion on the cerebral hemisphere of interest. Post thrombolysis, his NIHSS was 5. An MR scan revealed evidence of bilateral thalamic infarcts. After a period of rehabilitation, he was discharged home and independently mobile but with cognitive impairment. Acute stroke care increasingly uses multimodal imaging to confirm the clinical diagnosis and help optimise initial emergency management. Such imaging is useful in determining whether the presentation is a vascular event or stroke mimic. Moreover, seizures complicate and mimic acute strokes, which can lead to therapeutic uncertainty. This case highlights the increasingly sophisticated investigation of patients presenting with suspected acute stroke, with the attendant need for accurate interpretation by experienced clinicians. BMJ Publishing Group 2021-12-30 /pmc/articles/PMC8719119/ /pubmed/34969793 http://dx.doi.org/10.1136/bcr-2021-245723 Text en © BMJ Publishing Group Limited 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Case Report
Davis, Elizabeth
Elnagi, Fathalla
Smith, Thomas
CT perfusion: stroke, seizure or both?
title CT perfusion: stroke, seizure or both?
title_full CT perfusion: stroke, seizure or both?
title_fullStr CT perfusion: stroke, seizure or both?
title_full_unstemmed CT perfusion: stroke, seizure or both?
title_short CT perfusion: stroke, seizure or both?
title_sort ct perfusion: stroke, seizure or both?
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8719119/
https://www.ncbi.nlm.nih.gov/pubmed/34969793
http://dx.doi.org/10.1136/bcr-2021-245723
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