Evaluation of cerebral blood flow in older patients with status epilepticus using arterial spin labeling

Abstract

Introduction: Although older patients with status epilepticus (SE) have a high mortality rate and poor outcome, it is difficult to perform emergent electroencephalography (EEG) to diagnose SE in community hospitals. Arterial spin labeling (ASL) is a non-invasive magnetic resonance imaging (MRI) technique that can rapidly assess cerebral blood flow (CBF). Further, ASL can detect increased CBF in the ictal period. Therefore, ASL may be a useful tool for diagnosing SE in older patients. However, its effectiveness in this population is unknown.

Methods: We retrospectively investigated differences in CBF abnormalities between older patients (≥70 years) and non-older patients (<70 years) with SE using ASL. Participants were diagnosed with convulsive status epilepticus (CSE) or non-convulsive status epilepticus (NCSE) based on symptoms, brain MRI, and EEG.

Results: ASL detected CBF abnormalities in 40% of older patients with CSE or NCSE. Rates of CBF abnormalities in older patients were not significantly different compared with that in non-older patients.

Conclusions: ASL did not detect a higher rate of CBF abnormalities in older patients, but may help physicians diagnose SE in older patients in a community hospital setting if emergent EEG cannot be immediately performed.

Keywords: Arterial spin labeling; Magnetic resonance imaging; Non-convulsive status epilepticus; Older patient; Status epilepticus.

Fig. 1

An 85-year-old woman with right temporal intracerebral hemorrhage presenting with generalized tonic-clonic seizure. (A) Electroencephalography recording shows right-side lateralized periodic discharges (boxes). (B, C) Arterial spin labeling image shows hyperperfusion of cerebral blood flow in the right temporo-parietal lobe. Hyperperfusion is indicated by the red color. (D) Fluid-attenuated inversion recovery image displays an intracerebral hemorrhage (arrow) in the right temporal lobe. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)