Abstracts

Rationale: The exact physiology of postictal neurological deficits, such as Todd’s paresis, are not well understood. Reversible cerebral perfusion abnormalities have been described. Our aim of this study is to evaluate the characteristic features of hemodynamics during postictal state using MRI arterial spin labeling (ASL) and susceptibility-weighted imaging(SWI) in patients with postictal Todd’s paresis.  Methods: We retrospectively reviewed the data of 44 patients who transported by ambulance as seizure at Nagasaki University Hospital from 2015 to 2018. Total 15 patients underwent MRI ASL and SWI at first visit were included and analyzed in this study.  Results: Mean age was 69.2 years. All patients showed reversible hemiparesis or aphasia. 10 patients had previous intracranial disease (stroke, contusion, and tumor). Mean time of onset to MRI imaging was 113 minutes. ASL revealed hemispheric or local hypoperfusion in 8 patients, and hyperperfusion in 6 patients. There were the slow-waves on EEG of 3 patients who showed hypoperfusion on MRI. 4 of 6 patients who showed hyperperfusion had GTCS just before MRI. And SWI demonstrated prominence of ipsilateral draining veins in 11 patients. Conclusions: Perfusion changes in ASL seem to be related to epileptic focus and functional connected brain areas, and not correspond to a vascular territory. Hypoperfusion in postictal states might be result of active neuronal inhibition or postictal cerebral vascular dysfunction. SWI changes indicate increased deoxyhemoglobin within hypo/hyperperfusion territory. Extensive postictal perfusion changes must be discriminated from emerging stroke.  Funding: No funding