From http://www.arrs.org/ARRSLIVE/CaseOfTheWeek.

NEURORADIOLOGY: Vascular

Case Author: Megan K. Strother, MD, Vanderbilt University Medical Center

History

84-year-old man with altered mental status.

Imaging Findings

Parametric maps from CT perfusion study show increased cerebral blood flow (A), increased cerebral blood volume (B), and delayed mean transit time (C) in the right parietal lobe.

• Cerebral hyperperfusion syndrome
• Hypercapnia
• Ischemia
• Luxury perfusion following stroke
• Seizure

Diagnosis

Seizure

Teaching Points

The most common abnormal perfusion pattern on postictal CT perfusion images is hypoperfusion. Seizure is considered an etiologic factor when the hyperperfusion pattern does not fit a typical vascular distribution.

Suggested Readings

Deibler AR, Pollock JM, Kraft RA, Tan H, Burdette JH, Maldjian JA. Arterial spin-labeling in routine clinical practice. Part 3. Hyperperfusion patterns. AJNR 2008; 29:1428–1435
Warach S, Levin JM, Schomer DL, Holman BL, Edelman RR. Hyperperfusion of ictal seizure focus demonstrated by MR perfusion imaging. AJNR 1994; 15:965–968

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