CT perfusion abnormalities in status epilepticus: associations with clinical characteristics, EEG, and outcome measures.

OBJECTIVE

To investigate cerebral perfusion patterns on computed tomography perfusion (CTP) imaging in patients with status epilepticus (SE) and to evaluate their association with clinical, electrophysiological, and outcome parameters.

METHODS

We conducted a retrospective study of 117 patients (mean age 74.5 ± 12.1 years, 63 females) who underwent emergency CTP due to focal neurological deficits and suspected acute stroke; all patients were ultimately diagnosed with SE. Periictal CTP findings were analyzed and correlated with clinical characteristics, laboratory results, electroencephalographic (EEG) patterns, and patient outcomes.

RESULTS

Normoperfusion was the most common CTP finding (n = 54, 46.2%), followed by hypoperfusion (n = 36, 30.8%) and hyperperfusion (n = 27, 23.1%). Patients with CTP hyperperfusion had significantly longer hospital stays and longer SE duration (p < 0.05). Hyperperfusion was also more frequently associated with ictal EEG activity or lateralized periodic discharges (LPDs). Perfusion abnormalities outlining the boundaries of vascular territories were striking findings, observed in 80.9% of our patients with SE. At discharge, 70 patients (59.8%) had an unfavorable outcome, including 26 deaths (22.2%). Longer SE duration and poor treatment response were independent predictors of mortality. CTP abnormalities were not associated with SE etiology, seizure semiology, or overall functional outcome.

CONCLUSION

CTP may serve as a useful tool for early triage in centers with limited neurophysiological resources and may help suggest nonconvulsive SE in diagnostically unclear cases. Hyperperfusion on CTP appears to reflect disease severity and prolonged seizure activity rather than brain injury. Ictal EEG patterns can be associated with both hyperperfusion and hypoperfusion. CTP abnormalities are often associated with boundaries that are not confined to vascular territories. These findings underscore the importance of integrating imaging and electrophysiological data to improve the early diagnosis and management of SE.