STATUS EPILEPTICUS MIMICKING ACUTE ISCHEMIC STROKE: A CASE SERIES HIGHLIGHTING CROSSED CEREBELLAR DIASCHISIS

Background / Objective
Crossed cerebellar diaschisis (CCD) is a rare occurrence characterized by diminished functional activity in the cerebellar
hemisphere contralateral to supratentorial injury, resulting from decreased cerebellar blood flow and metabolism. While
typically associated with ischemic stroke, this phenomenon may also manifest in cases of status epilepticus
Methods
A prospective observational study was conducted at a tertiary university hospital, wherein clinical and radiological findings
were systematically evaluated
Results
The initial patient, a 45-year-old woman with a prolonged history of alcohol abuse, was admitted to a tertiary university
hospital after experiencing a generalized tonic-clonic seizure. On admission, she presented with a severe condition, scoring
a Glasgow Coma Scale (GCS) of-7. Despite administration of diazepam, no effect was observed. Non-enhanced computed
tomography (NECT) of the brain revealed a mildly hypodense acute ischemic area spanning the left cerebral hemisphere,
excluding the basal ganglia. Computed tomography angiography (CTA) highlighted pronounced vasodilation with no
evidence of arterial occlusion. Epileptiform activity on electroencephalogram (EEG) was only detected on the fourth day of
admission. Brain magnetic resonance imaging (MRI) unveiled extensive cytotoxic edema in the left hemisphere and a
smaller lesion in the right cerebellum – a case of crossed cerebellar diaschisis (CCD). Despite therapy in the intensive care
unit (ICU), the patient's clinical state deteriorated. However, gradual improvements were observed, leading to her
re-admission to the neurology department. She was discharged with a partially reversible and suboptimal outcome.
The second patient, a 36-year-old man, presented with multiple generalized tonic-clonic seizures, fever, and a history of
traumatic intracerebral hematoma in the right hemisphere, which had been surgically treated during adolescence. He also
had a prolonged history of alcohol abuse, with a GCS score of 3 upon arrival at the emergency department. The patient was
sedated and intubated upon admission. Brain NECT revealed pansinusitis and post-traumatic lesions in various brain
regions, including both frontal lobes, the right parietal lobe, and temporal lobes. Subsequently, he was transferred to the
ICU. Focal epileptiform activity was noted on EEG on the second day of admission, followed by a pattern of slow,
disorganized background activity in subsequent EEG readings. Brain MRI confirmed extensive post-ictal damage in the right
hemisphere and a smaller lesion in the contralateral cerebellar hemisphere, indicative of CCD. Although slight improvements
were observed, the patient was re-admitted to the neurology department with limited hope for full recovery.
Conclusions
Status epilepticus, a life-threatening condition, can often resemble stroke, making accurate diagnosis crucial. These case
series underscore the critical importance of timely and accurate diagnosis, as well as effective management of status
epilepticus. Additionally, they shed light on the rare occurrence of crossed cerebellar diaschisis, which may manifest
concurrently, emphasizing the need for comprehensive evaluation and treatment