Periictal hyperperfusion in the perituberal cortex revealed by arterial spin labeling perfusion images in a patient with tuberous sclerosis complex

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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
  • Mugita Fumihito
    Department of Neurosurgery, Hachisuga Hospital
  • Mukae Nobutaka
    Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
  • Shimogawa Takafumi
    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

Description

<p>Introduction: Although drug-resistant epilepsy is a frequent symptom in patients with tuberous sclerosis complex (TSC), there is conflicting evidence regarding whether the epileptogenic zone is present in the tuber itself or in the abnormally developed perituberal cortex.</p><p>Case report: A 45-year-old man with TSC developed clustering of generalized tonic-clonic seizures (GTCSs) that lasted for approximately 1 day. Magnetic resonance imaging, including arterial spin labeling (ASL) perfusion images, was performed approximately 4 hours after the last apparent seizure. The fusion image of the ASL and fluid-attenuated inversion recovery sequence clearly demonstrated that the ASL hyperperfusion site was located in the perituberal cortex of the left frontal lobe, where the tubers were most prominent.</p><p>Conclusion: The present study suggests epileptogenicity of the perituberal cortex for GTCSs in this patient. In the future, the epileptogenicity of TSC may be further clarified by conducting ictal or periictal ASL in a large number of TSC patients.</p>

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