Guerrero et al. International Journal of Emergency Medicine 2012, 5:4 http://www.intjem.com/content/5/1/4 Page 2 of 4 homonymous hemianopsia. He presented within 3 h of symptom onset, and perfusion CT was obtained per the stroke protocol at our institution. Non-contrast CT did not reveal any early signs of stroke or hemorrhage. The CT angiogram was unremarkable. Perfusion CT demon- strated an area of shortened mean transit time (MTT), increased cerebral blood volume (CBV), and increased cerebral blood flow (CBF) in the right occipital territory (Figure 1). Given the patient’s left homonymous hemia- nopsia, the findings on perfusion CT were interpreted as a hyperperfusion phenomenon. The differential diagnosis included epileptiform activity as well as other pathologies not limited to glioma and misery perfusion syndrome. Thus, an EEG was obtained, and it confirmed nonconvulsive seizure activity from the right parieto- occipital quadrant. This patient was eligible for intrave- nous thrombolysis given the neurological findings and NIHSS of 2; however, the constellation of the above findings led to our clinical decision not to administer thrombolytics in the setting of a seizure diagnosis. The patient was loaded with Ativan, Fosphenytoin, and Depakote in order to stop the seizures. Once the Figure 1 CT perfusion study demonstrating (a) shortened mean transit time in the right occipital territory (arrow). Corresponding area of increased cerebral blood volume (b) and increased cerebral blood flow (c). FLAIR MRI brain (d) without evidence of infarct.