Hemodynamics of ictal hyperperfusion in an epileptic patient with dual pathology revealed by arterial spin labeling perfusion image with triple postlabeling delays

Abstract

The hemodynamics of ictal hyperperfusion in dual pathology was evaluated using arterial spin labeling perfusion images (ASL) with triple postlabeling delays (PLDs). A 62-year-old man with epileptogenic right parietal hematoma cavity and bilateral hippocampal atrophy, particularly on the right, underwent ASL examination during subtle non-convulsive status epilepticus immediately after focal-to-bilateral tonic-clonic seizures. ASL at PLD of 1.5 s showed increased signals in the gray matter of both hemispheres, in addition to the peri-cavitary cortex. At PLD of 1.75 s, these signals were mostly washed out, and there was a marked increase in signals localized to bilateral hippocampal heads. The hippocampal signals were also mostly washed out at PLD of 2.0 s. These findings indicate a close relationship between activities originating from the peri-cavitary cortex and the hippocampus in this case. In terms of the mechanism of hippocampal atrophy, the oxygen supply required for large epileptic activities could not be met.