European Radiology

, Volume 28, Issue 5, pp 1791–1800 | Cite as

Advanced CT for diagnosis of seizure-related stroke mimics

  • Friederike AusteinEmail author
  • Monika Huhndorf
  • Johannes Meyne
  • Helmut Laufs
  • Olav Jansen
  • Thomas Lindner


Background and purpose

It is assumed that up to 30 % of clinically diagnosed acute ischaemic strokes (AIS) are actually stroke mimics (SM). Our aim was to evaluate the usefulness of advanced CT including CT angiography (CTA) and CT perfusion (CTP) findings when distinguishing AIS from seizure-related SM.


Over a 22-month period data were gathered of patients who presented to our stroke centre with AIS-like symptoms and were examined immediately with an advanced CT, analysed and evaluated by two experienced neuroradiologists who preferred SM rather than AIS. All these patients additionally received electroencephalography and follow-up imaging. CTA was the important feature to exclude vessel occlusion or haemodynamic relevant stenosis. Perfusion patterns were retrospectively analysed qualitatively.


The most common perfusion abnormality was cortical hyperperfusion (22/37 [59.5 %] patients) followed by a hypoperfusion pattern with a cortical-subcortical involvement (15/37 [40.5 %] patients) without evidence of vessel occlusion or stenosis. Seizure-related hyper- and hypoperfusion patterns typically crossed the normal anatomical vascular territories boundaries.


Beyond its use in core and penumbra estimation, advanced CT provides important information to emergency physicians in the difficult clinical diagnosis when differentiating between AIS and seizure-related symptoms with an important impact on therapeutic decision-making.

Key points

• Advanced CT helps to differentiate between ischaemic strokes and stroke mimics.

• Seizure-related perfusion patterns are distinct from ischaemia hypoperfusion.

• Advanced CT could improve rapid adequate treatment for AIS and seizure events.


Multidetector computed tomography Perfusion Stroke Seizures Decision making 



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Thomas Lindner.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because of the retrospective anonymous data analysing without any impact to therapy decision making.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• diagnostic

• performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  1. 1.Department of Radiology and NeuroradiologyUniversity Hospital Schleswig-Holstein, Campus KielKielGermany
  2. 2.Department of NeurologyUniversity Hospital Schleswig-Holstein, Campus KielKielGermany

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