Absence of periictal hyperperfusion on arterial spin labeling perfusion images in a patient with posttraumatic epilepsy and underdevelopment of ipsilateral internal carotid and middle cerebral arteries

Abstract

Arterial spin labeling (ASL) perfusion images allow noninvasive visualization of periictal hyperperfusion in epileptically activated areas occurring secondary to seizures in structural focal epilepsy, and demonstrate a close anatomical relationship between epileptogenic lesions and the activated area. A 27-year-old female patient with epilepsy presented with focal to bilateral tonic-clonic seizures. She had an extensive traumatic lesion in the perfusion area of the right middle cerebral artery (MCA), which occurred at 3 years of age. ASL with triple postlabeling delays (PLDs) imaged 1 hour after the seizure failed to reveal periictal hyperperfusion around the lesion. It was possible that because of the underdevelopment of the right internal carotid artery and MCA, the blood supply to the right hemisphere was not adequate to demonstrate ictal hypermetabolism. ASL results should be interpreted comprehensively by combining the clinical manifestations, electroencephalographic findings, and magnetic resonance (MR) imaging findings of various modalities including MR angiography.