Specificities of arterial spin labeling (ASL) abnormalities in acute seizure - 13/12/18

Doi : 10.1016/j.neurad.2018.11.003

Joseph Schertz ^a, Mathieu Benzakoun ^a, Nadya Pyatigorskaya ^a,^b, Samia Belkacem ^a, Melika Sahli-Amor ^a, Vincent Navarro ^c, Clément Cholet ^a, Delphine Leclercq ^a, Didier Dormont ^a,^b, Bruno Law-ye ^a,^⁎
^a AP–HP, groupe hospitalier Pitié-Salpêtrière, neuroradiology department, 75013 Paris, France
^b Sorbonne universités, Pierre and Marie-Curie faculty of medicine, 75013 Paris, France
^c AP–HP, groupe hospitalier Pitié-Salpêtrière, epileptology department, 75013 Paris, France

^⁎Corresponding author at: Neuroradiology department, hospital Pitié-Salpêtrière, 47–83, boulevard de l’Hôpital 75013, Paris, France.Neuroradiology departmenthospital Pitié-Salpêtrière47–83, boulevard de l’HôpitalParis75013France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 13 December 2018
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Highlights

•	ASL is useful to detect and characterize acute seizure.
•	In acute deficit, ASL can comfort seizure diagnosis and rule out stroke.
•	ASL abnormalities are well correlated with EEG findings.
•	ASL is more sensitive than conventional MR sequences of seizure identification.
•	Compared with other pathological causes of hyperperfusion, such as migraine or luxury perfusion in stroke, ASL exhibits some specific aspects especially remote pulvinar and contralateral cerebellar activation.

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Abstract

Purpose

Arterial spin labeling (ASL) is a non-invasive tool measuring cerebral blood flow (CBF) and is useful to assess acute neurological deficit. While acute stroke presents as hypoperfused vascular territory, epileptic activity causes cortical hyperperfusion. Other neurological conditions exhibit hyperperfusion, like migraine or secondary “luxury perfusion” in strokes. Our objectives were to evaluate the usefulness and potential specificities of ASL in acute seizure and correlate it with electroencephalogram.

Materials and methods

Amongst a cohort of patients with neurological deficit, addressed for suspicion of stroke, we retrospectively reviewed 25 consecutive patients with seizures who underwent magnetic resonance imaging (MRI) with ASL and electroencephalography (EEG). We compared them with a control group of patients with migraine and stroke secondary re-perfusion, exhibiting ASL hyperperfusion.

Results

Lateralized cortical hyperperfusion (high relative CBF) was observed in all patients. Good topographic correlation with EEG was found in 18 patients (72%). Eight (32%) had hyperperfusion of ipsilateral pulvinar, 5 (20%) had hyperperfused contralateral cerebellar hemisphere, 16 (64%) presented diffusion abnormalities and 20 (80%) had underlying epileptogenic lesions. Pulvinar hyperperfusion was not observed in the control group, nor were diffusion abnormalities in migrainous patients. Contralateral cerebellar hyperperfusion was observed in two migrainous patient, without associated pulvinar activation, whereas all patients with cerebellar hyperperfusion in the study group had associated pulvinar activation.

Conclusions

Elevated CBF can be observed in the epileptogenic zone, ipsilateral pulvinar and contralateral cerebellum (diaschisis) in seizure. These abnormalities seem specific when compared with other causes of hyperperfusion. Arterial spin labeling can be highly effective in the differential diagnosis of strokes.

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Keywords : Arterial spin labeling, Cerebral blood flow, Perfusion, Seizure, Stroke, EEG