Qualitative Assessment of Cerebral Perfusion in Post Stroke Seizure Patients using Arterial Spin Labeling: A Case-control Study

Abstract

Introduction: Arterial Spin Labeling-Perfusion Weighted Imaging (ASL-PWI) assesses cerebral blood flow using magnetically labeled inflowing arterial blood water protons as freely diffusible tracer without exogenous contrast agent. Seizures are one of the sequelae of stroke with its mechanism not well studied. Aim: Qualitative assessment of cerebral perfusion in post stroke seizure patients using ASL-PWI and comparison of perfusion patterns in post stroke seizure patients and stroke patients. Materials and Methods: This was a case-control study among 100 stroke patients who underwent Magnetic Resonance Imaging (MRI) of brain in Department of Radiodiagnosis, from Outpatient and Inpatient Department of Neurology, Christian Medical College, Ludhiana, Punjab, India, from 1st January 2018 till 1st January 2020. Total 50 post stroke seizure patients included as cases and 50 age matched post stroke patients without seizure included as controls. Perfusion pattern was compared qualitatively using ASL-PWI. Qualitative variables were associated using Chi-square test/Fisher’s-exact test. Results: The mean age of the study subjects were 56.38±16.98 years (age range from 19-87 years) and that of controls were 59.66±11.86 years (age range from 19-89 years) (p-value=0.265). Cerebral hypoperfusion was noted in 39 (78%) of total 50 post stroke seizure patients irrespective of type of stroke. Cortical and subcortical area of frontal and parietal lobes was predominantly involved in post stroke seizure patients. Out of 39, 23 (71.88%) early onset seizure and 16 (88.89%) late onset seizure patients had hypoperfusion. There was no significant association of perfusion abnormality with onset of seizure (p-value=0.241). Hypoperfusion was noted in cases and controls without any statistical difference. Conclusion: Cortical and subcortical area of involvement was noted in post stroke seizure patients. Post stroke seizure patients showed hypoperfusion irrespective of stroke type and onset of seizure. There was no difference seen in perfusion abnormality between post stroke seizure patients and stroke patients without seizure.