Abstracts

Rationale: We aim to describe the Ictal perfusion abnormalities seen by arterial spin labeled sequences (ASL) of MRI in single partial seizures. Methods: We report two cases of patients with focal epilepsies that underwent an ictal-MRI that included ASL, during a single parcial seizure. Case 1 was a right temporal posttraumatic epilepsy, experiencing complex partial seizures characterized by ictal verbalization. Structural MRI showed right temporal microbleedings suggestive of posttraumatic axonal injury. Case 2 was a right posterotemporal tumoral epilepsy, having audiogenic seizures. Structural MRI showed a tumor located in the right middle temporal gyrus. Results: Both cases showed an area of hyperperfusion seen by ASL matching the area of seizure onset as recorded in a prior Video-EEG monitoring. Such findings were normalized in a follow-up MRI one month later, with patients seizure free for more than 24 hours. In Case 1 language dominance was located with functional-MRI (BOLD) over the left hemisphere. In case 2 findings on ASL were exactly correlated to the images obtained by SISCOM. Conclusions: Focal hyperperfusion observed by Ictal-MRI in single focal seizures, may have localizing value; since they are well correlated to clinical, EEG and SPECT findings.