Brain perfusion imaging in patients with status epilepticus, seizures, and IIC patterns

• Hyperperfusion on brain perfusion imaging is specific for seizure conditions. • Their sensitivity for SE is enhanced when thalamic hyperperfusion is present. • Brain perfusion imaging accuracy is variable in diagnosing seizures. Over the past decade, Computed Tomography perfusion (CTP) and Magnetic Resonance Perfusion (MRP) imaging have become increasingly valuable tools in the assessment of acute neurological emergencies, including stroke and stroke mimics. These modalities can demonstrate seizure-related alterations in regional cerebral blood flow across the spectrum of epileptic conditions. While ictal states classically manifest as regional hyperperfusion and interictal periods typically show hypoperfusion or normal perfusion, the perfusion patterns are more nuanced and influenced by several variables. This review examines the current literature on CTP and MRP applications in status epilepticus, seizures, and ictal-interictal continuum patterns, with particular emphasis on the comparative diagnostic accuracy across different clinical scenarios and imaging techniques.