{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:10:03Z","timestamp":1756375803359,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2021,12,30]],"date-time":"2021-12-30T00:00:00Z","timestamp":1640822400000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,11,25]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:p>An 88-year-old male with a history of hypertension, ischaemic heart disease and Bell\u2019s palsy presented with symptoms and signs of an acute ischaemic stroke. National Institutes of Health Stroke Scale (NIHSS) was 19 at presentation, indicative of potential large vessel occlusion. The initial CT scan revealed evidence of small vessel disease and arterial calcification. As there were no contraindications, he received thrombolytic treatment. CT angiography and CT perfusion imaging were performed in preparation for possible thrombectomy. There was no evidence of a large vessel thrombus, and changes on CT perfusion were suggestive of seizure activity, with relative hyperperfusion on the cerebral hemisphere of interest. Post thrombolysis, his NIHSS was 5. An MR scan revealed evidence of bilateral thalamic infarcts. After a period of rehabilitation, he was discharged home and independently mobile but with cognitive impairment.<\/jats:p>\n               <jats:p>Acute stroke care increasingly uses multimodal imaging to confirm the clinical diagnosis and help optimise initial emergency management. Such imaging is useful in determining whether the presentation is a vascular event or stroke mimic. Moreover, seizures complicate and mimic acute strokes, which can lead to therapeutic uncertainty. This case highlights the increasingly sophisticated investigation of patients presenting with suspected acute stroke, with the attendant need for accurate interpretation by experienced clinicians.<\/jats:p>","DOI":"10.1136\/bcr-2021-245723","type":"journal-article","created":{"date-parts":[[2021,12,30]],"date-time":"2021-12-30T08:33:59Z","timestamp":1640853239000},"page":"e245723","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["CT perfusion: stroke, seizure or both?"],"prefix":"10.1136","volume":"14","author":[{"given":"Elizabeth","family":"Davis","sequence":"first","affiliation":[{"name":"St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fathalla","family":"Elnagi","sequence":"additional","affiliation":[{"name":"Stroke, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Smith","sequence":"additional","affiliation":[{"name":"St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,12,30]]},"reference":[{"key":"2025082802383774000_14.12.e245723.1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0404.2001.00141.x"},{"key":"2025082802383774000_14.12.e245723.2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000087786.38997.9E"},{"key":"2025082802383774000_14.12.e245723.3","doi-asserted-by":"publisher","DOI":"10.1007\/BF00315956"},{"key":"2025082802383774000_14.12.e245723.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2006.01.047"},{"key":"2025082802383774000_14.12.e245723.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-012-1548-1"},{"key":"2025082802383774000_14.12.e245723.6","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A2044"},{"key":"2025082802383774000_14.12.e245723.7","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.028337"},{"key":"2025082802383774000_14.12.e245723.8","unstructured":"Rudd AG , Bowen A , Young G , et al . 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Neurology 2014;82.","DOI":"10.1212\/WNL.82.10_supplement.P3.005"},{"key":"2025082802383774000_14.12.e245723.11","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1016\/j.crad.2015.06.078","article-title":"Acute CT perfusion changes in seizure patients presenting to the emergency department with stroke-like symptoms: correlation with clinical and electroencephalography findings","volume":"70","author":"Payabvash","year":"2015","journal-title":"Clin Radiol"},{"key":"2025082802383774000_14.12.e245723.12","doi-asserted-by":"crossref","first-page":"I","DOI":"10.1177\/2396987321989865","article-title":"European stroke organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke","volume":"6","author":"Berge","year":"2021","journal-title":"Eur Stroke J"},{"key":"2025082802383774000_14.12.e245723.13","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.009012"},{"key":"2025082802383774000_14.12.e245723.14","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.000126"},{"key":"2025082802383774000_14.12.e245723.15","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1002\/ana.25582","article-title":"Intravenous thrombolysis for suspected ischemic stroke with seizure at onset","volume":"86","author":"Polymeris","year":"2019","journal-title":"Ann Neurol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-245723","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:38:43Z","timestamp":1756373923000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-245723"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":15,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,30]]},"published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.1136\/bcr-2021-245723"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-245723","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,12]]}}}