Detection of slightly increased signals in temporal lobe on periictal arterial spin labeling perfusion image for initial suspicion of temporal lobe epilepsy

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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: Magnetic resonance (MR) perfusion imaging with arterial spin labeling (ASL) can easily detect periictal hyperperfusion accompanying epileptic seizures. Herein, we report two cases in which ASL performed immediately after a seizure was useful for the initial suspicion of temporal lobe epilepsy (TLE).</p><p>Case report: Patients 1 and 2 developed focal-to-bilateral tonic-clonic and focal impaired awareness seizures, respectively, and were subsequently transferred to our facility for out-of-hours service. On emergent ASL MR perfusion imaging, a slight increase in signals from the hippocampus and lateral temporal lobe was observed in both patients. However, routine electroencephalography (EEG) performed from 12 h to two days later showed corresponding paroxysmal discharges only in Patient 2.</p><p>Conclusion: These cases suggest that MR imaging with ASL perfusion, which can be performed 24 hours a day, is useful for the initial suspicion of TLE, compensating for the limitation of routine EEG. However, to ensure a definitive diagnosis, it is important to evaluate the result together with clinical history, seizure semiology and findings of other modalities centered on EEG.</p>

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