Arterial spin labeling MR perfusion image in differentiating metabolic encephalopathy from non-convulsive status epilepticus in a patient with generalized periodic discharges with triphasic morphology

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  • Oketani Hiroshi
    Department of Neurosurgery, Hachisuga Hospital
  • Morioka Takato
    Department of Neurosurgery, Hachisuga Hospital
  • Inoha Satoshi
    Department of Neurosurgery, Hachisuga Hospital
  • Miki Kenji
    Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
  • Shimogawa Takafumi
    Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
  • Mukae Nobutaka
    Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
  • Sakata Ayumi
    Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital
  • Shigeto Hiroshi
    Department of Neurology, Graduate School of Medical Sciences, Kyushu University
  • Yoshimoto Koji
    Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University

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<p>Introduction: Arterial spin labeling (ASL) magnetic resonance (MR) perfusion imaging is useful for diagnosing non-convulsive status epilepticus (NCSE) as it visualizes ictal hyperperfusion in epileptically activated areas.</p><p>Case report: A 94-year-old woman presented with inability to communicate. An electroencephalogram revealed generalized periodic discharges with triphasic morphology. However, as her liver and kidney function were normal, it was difficult to distinguish metabolic encephalopathy from NCSE. ASL showed not only diffuse hypoperfusion in the cerebral parenchyma, instead of ictal hyperperfusion, but also marked appearance of arterial transit artifact in the major arteries, probably due to stagnant flow. The patient was therefore diagnosed with hyperammonemic encephalopathy (ammonia level 128 mg/dL) induced by constipation. Along with normalization of the ammonia level, the mental status and ASL findings improved.</p><p>Conclusion: In this case, ASL helped visualize the decreased blood flow and velocity secondary to hypometabolism. The addition of ASL to conventional MR images may be useful in differentiating metabolic encephalopathy from NCSE, particularly in neuroemergency situations.</p>

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  • Epilepsy & Seizure

    Epilepsy & Seizure 15 (1), 59-66, 2023

    一般社団法人 日本てんかん学会

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