PMC6328911_01
Imaging acquired on admission of a 64-year-old woman with non-convulsive status epilepticus. A, Magnetic resonance (MR) diffusion-weighted (scan time, 56 s). B, T2-weighted (scan time, 2 min 16 s). C, Fluid-attenuated inversion recovery (scan time, 2 min 46 s). D, T2*-weighted (scan time, 2 min 4 s). E, MR angiography (scan time, 5 min 24 s). F, Arterial spin-labeling perfusion map (post-label delay of 1,525 ms [default standard]; scan time, 2 min 32 s) shows states of hyperperfusion as focal areas of signal intensity increase in the right hemisphere.
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MRI scanner (SIGNA; GE Healthcare, Little Chalfont, Buckinghamshire, UK) revealed mild periventricular white matter ischemic changes, but there was no diffusion restriction on the diffusion-weighted image nor findings suggesting bleeding on T2*-weighted images (Fig. 1A-D). Magnetic resonance angiography showed a mildly increased signal intensity of the left middle cerebral artery with no arterial steno-occlusive lesions (Fig. 1E). Subsequently, acquired ASL images using pseudo-continuous arterial spin-labeling (pCASL) perfusion (3D ASL, HDxtVer 23; GE Healthcare) showed focal hyperperfusion in the right temporal region (Figs. 1F, 2A). Follow-up MRI was carried out on the 10th day in hospital in response to the patient having been asymptomatic for more than 24 h; the scan showed normalized CBF (Fig. 1D-F).
Imaging and electroencephalography (EEG) of a 64-year-old woman with non-convulsive status epilepticus. A, Arterial spin-labeling (ASL) perfusion map depicts states of hyperperfusion (short post-label delay [PLD] of 1,025 ms) as focal areas of signal intensity increase in the right hemisphere on admission, which was diminished by antiepileptic treatment on follow-up exam 10 days later. In this case, standard PLD (1,525 ms) was used for the follow-up study because of incomplete labelled blood in the whole brain. B, EEG reveals decreased photic drive response in the right hemisphere (middle left panel), followed by periodic, generalized epileptiform discharges with muscle artifact contaminations (middle right panel), terminating in the baseline patterns after presenting right occipital dominant 3 Hz slow waves (right panel). ECG, electrocardiogram; EOG(R), electrooculogram for the right eye; IPS, intermittent photic stimulation (20 Hz, 10 s) (left panel).
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Subsequently, acquired ASL images using pseudo-continuous arterial spin-labeling (pCASL) perfusion (3D ASL, HDxtVer 23; GE Healthcare) showed focal hyperperfusion in the right temporal region (Figs. 1F, 2A). An EEG on the second day in hospital showed decreased photic drive response in the right hemisphere to intermittent photic stimulation (20 Hz, 10 s) followed by periodic, generalized epileptiform activities with contamination of muscle artifacts accompanied by brief seizures of facial muscles, terminating in the baseline EEG patterns within 80 s (Fig. 2B).
PMC6328911_02
Non-convulsive status epilepticus in a 52-year-old man detected by magnetic resonance imaging (MRI)-pseudo-continuous arterial spin-labeling (ASL). Diffusion-weighted (A) and ASL perfusion MRI (B). ASL perfusion map (short post-label delay of 1,025 ms) depicts states of hyperperfusion as focal areas of signal intensity increase in the right temporal lobe on admission, which was diminished by antiepileptic treatment until day 5 of the symptom onset.
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Hyperperfusion around the scar was more prominently detected by ASL rather than increased cortical abnormal signals on diffusion-weighted imaging (Fig. 3).