Stroke Seizures Research Articles

A Comparative Study Between Levetiracetam and Phenytoin to Find Out Their Use in Prevention of Seizures in Stroke Patient

The aim of this study is to do comparison between Levitracetam and Phenytoin to find out their use in prevention of seizures in Stroke patients. Objectives: To determine the effect of Levetiracetam in stroke patients. To determine the effect of Phenytoin in stroke patients. To determine the role of antiepileptic therapy in primary prevention of stroke seizures. To find out the most effective drug between Levetiracetam & Phenytoin

To what extent does frailty mediate the association between age and the outcomes of brain reperfusion following acute ischemic stroke?

ObjectiveWe evaluated the extent to which frailty mediated the association between age, poor functional outcomes, and mortality after acute ischemic stroke when patients were treated with brain reperfusion (thrombolytic therapy and/or thrombectomy).Materials and methodsThis retrospective cohort study included patients diagnosed with ischemic stroke who had undergone intravenous cerebral reperfusion therapy and/or mechanical thrombectomy. We created a mediation model by analyzing the direct natural effect of an mRS score > 2 and death on age-mediated frailty according to the Frailty Index.ResultsWe enrolled 292 patients with acute ischemic stroke who underwent brain reperfusion. Their mean age was 67.7 ± 13.1 years. Ninety days after the stroke ictus, 54 (18.5%) participants died, and 83 (28.4%) lived with moderate to severe disability (2 < mRS < 6). In the mediation analysis of the composite outcome of disability (mRS score > 2) or death, frailty accounted for 28% of the total effect of age. The models used to test for the interaction between age and frailty did not show statistically significant interactions for either outcome, and the addition of the interaction did not significantly change the direct or indirect effects, nor did it improve model fit.ConclusionFrailty mediated almost one-third of the effect of age on the composite outcome of disability or death after acute ischemic stroke.

PRINCIPLES OF MANAGEMENT OF PATIENTS WITH POST-STROKE SEIZURES

Statistically, in 1 in 10 adult patients, first-onset epilepsy is associated with a history of stroke, and this aetiology occurs in 1 in 4 patients aged 65 years and older with epilepsy. Incidence rates are higher in patients with intracranial, that is, intracerebral or subarachnoid haemorrhage. Haemorrhage increases the risk of seizures by up to 10- 16%. The risk of subsequent development of epilepsy is highest in patients with remote and sequelae of ischaemic stroke. Classification of seizures in stroke and their frequency Seizures develop in different stages of stroke. Depending on the time of onset, they can be divided into the following types: precursor seizures, early and late seizures. Unfortunately, there is currently no consensus among neurologists about the timing of the onset of these seizures . The most common definitions are that early attacks are those that occurred in the first 24-48 h, the first week, the first 2 weeks, and 1 month from the onset of stroke.

P436 ASSOCIATION BETWEEN REVERSE–TAKO–TSUBO E NEUROLOGICAL DISORDER

Abstract Reverse–Tako–tsubo (r–TTC) is a rare variant of Tako–tsubo syndrome (TTC). TTC is characterized by transient and reversible left ventricular systolic dysfunction, for which an emotional or physical stressful trigger can usually be identified. Clinically, it mimics an acute myocardial infarction, with elevation of myocardial cytonecrosis enzymes and no obstractive coronary artery stenosis. On imaging, r–TTC is characterized by hypokinesia of the mid–basal regions associated with hyperkinesia of the apical region that resolves spontaneously. Case report: 78–year–old female affected by cerebral atrophy, leukoencephalopathy, cognitive impairment, behavior disorders. Reported episode of loss of consciousness lasting several minutes, associated with spontaneously resolving tremors and left hemisome hyposthenia. When she arrived in the emergency room, the haematological tests found high troponin values. On CT brain without contrast, no evidence of alterations of the encephalic tissues referable to acute lesions, but it showed of diffuse supratentorial leukoaraiosis and widening of the cerebrospinal fluid spaces on an atrophic basis. The neurological evaluation excludes the presence of a seizure. The electrocardiogram showed diffuse negative T waves and QTc 636 ms. The coronary angiography didn’t show significant coronary arteries stenosis and the ventriculography showed normal ventricular dimensions with total akinesia of the mid segments and normokinesia of the apical region with an ejection fraction of 50%. With these findings a diagnosis of mid left ventricular Tako–tsubo (r–TTC) was made. Transthoracic color Doppler echocardiography confirmed the alterations of the left ventricular kinetics observed by ventriculography. Conclusions compared to CTT, r–TTC is associated with a lower decline in global systolic function and, as reported in the literature, there is a greater connection to neurological insults as triggering factors, such as episodes of aneurysmal subarachnoid hemorrhage, brain surgery, ischemic stroke seizures and traumatic brain injury. The underlying mechanisms are still unknown, a crucial role in catecholamine–induced cardiotoxicity, coronary microvascular dysfunction or coronary vasospasm and/or estrogen deficiency is hypothesized.

Cortical Involvement of a Recent Infarct Contralateral to Early Focal Seizures in Ischemic Stroke.

Objective To investigate the frequency and clinical characteristics of ischemic stroke patients with early seizures, especially with cortical involvement contralateral to their focal seizures. Methods We retrospectively studied patients with ischemic stroke admitted to our hospital. We compared the clinical characteristics of patients with and without early seizures (occurring within seven days of the stroke onset). In addition, we divided the patients with early focal seizures into two groups (patients with and without cortical involvement of a recent infarct contralateral to their focal seizure) and compared the clinical characteristics of the groups. Results Of the 5,806 patients with ischemic stroke, 65 (1.2%) were diagnosed with early seizures. A history of ischemic stroke [odds ratio (OR) 1.71], a history of seizures (OR 27.58), and a National Institutes of Health Stroke Scale score on admission (OR 1.07) were significant and independent factors associated with the presence of early seizures. Of these 65 patients, 56 had focal seizures, while the others had generalized or undetermined seizures. Cortical involvement of a recent infarct contralateral to their focal seizures was observed in 24 of these 56 patients (43%). Glucose and hemoglobin A1c levels were significantly higher in patients with cortical involvement of a recent infarct contralateral to their focal seizures than in those with infarcts in other regions. Conclusion These findings suggest that recent infarcts play a role as systemic causes of acute symptomatic seizures as well as an epileptogenic lesion in ischemic stroke patients with early focal seizures.

Hyperglycemia-induced hemichorea in a Diabetic patient with accompanying post stroke seizure: A case report

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Incidence and predictors of post stroke seizure among adult stroke patients admitted at Felege Hiwot compressive specialized hospital, Bahir Dar, North West Ethiopia, 2021: a retrospective follow up study

BackgroundA post stroke seizure is a period of neurological dysfunction caused by abnormal neuronal activity. Seizures after a stroke have an impact on patients' lives and increase mortality in stroke patients. It also has a negative impact on the prognosis of stroke. However, there is a scarcity of literature in Ethiopia on the occurrence of post-stroke seizures. Therefore, this study aimed to assess the incidence and predictors of post-stroke seizure at Felege Hiwot compressive specialized hospital, North West Ethiopia.MethodsAn institution-based retrospective follow-up study was carried out at Felege Hiwot Compressive Specialized Hospital, North West Ethiopia from July 1, 2017 to June 30, 2021. The records of 568 stroke patients were reviewed using a random sample method. To find predictors of post-stroke seizures, we applied the log-binomial regression model.ResultThe incidence of post-stroke seizures was 22.18%( 95% CI 18.83%—25.83%). Older age group (ARR = 2.49, 95% CI 1.33–4.69), hemorrhagic stroke (ARR = 1.99, 95% CI 1.25–3.17), surgical intervention (ARR = 1.85, 95% CI 1.22–2.81), and tramadol medication (ARR = 1.85, 95% CI 1.22–2.81) were found to be predictors of post stroke seizure.ConclusionThis study revealed that the incidence of post stroke seizure was high and older age, haemorrhagic type of stroke, surgical management, and use of tramadol anti-pain medication are risk factors for post-stroke seizures. Therefore, health care professionals must pay special attention and provide clinical care to patients who have risk factors for post-stroke seizure.

Early Post-stroke Seizures in Acute Ischaemic Stroke: A Retrospective Study

Introduction: Seizures represent an important complication of ischaemic stroke causing a substantial burden to post-stroke patients. Seizures occurring within one week after acute stroke onset are called early onset seizures. Several studies have tried to identify the risk factors for early seizures after stroke with controversial results. Aim: To determine the risk factors of early post-stroke seizures in a retrospective cohort of acute ischaemic stroke. Materials and Methods: This retrospective cohort study included medical records of 552 adult patients with acute ischaemic stroke between March 2017 to September 2022 admitted at Travancore Medical College Hospital, Kollam, Kerala, India. The patients were divided into two groups-stroke patients with early onset seizures and stroke patients without early onset seizures. The following parameters were compared between the two groups-age, gender, presenting symptoms, ischaemic subtype (TOAST {Trial of Org 10172 in Acute Stroke Treatment} classification), vascular territory involved, lesion location and lateralisation, infarct size, stroke severity based on National Institute of Health Stroke Scale (NIHSS), vascular risk factors, treatment (thrombolysis, antiplatelets, anticoagulants use) and related complications (haemorrhagic transformation, infection, gastrointestinal haemorrhage, hyponatraemia). Univariate analysis was done using Chi-square test and multivariate analysis using logistic regression test. Statistical Package for the Social Sciences (SPSS) version 27.0 statistical software was used, p-value<0.05 was considered statistically significant. Results: Among 552 patients, 76 (13.8%) were stroke patients with early onset seizure group and 476 (86.2%) were stroke patients without early onset seizure group. A total of 84.2% of patients developed seizure within 24 hours of stroke onset. A total of 409 (74.1%) patients were males. Patients with early onset seizures were younger. The most common seizure type was unknown onset to bilateral tonic-clonic seizures (85.5%). Multivariate analysis identified severe NIHSS, supratentorial, cortical location, large artery disease, anticoagulation use, haemorrhagic transformation and hyponatraemia as independent factors for early onset seizures. Conclusion: Severe NIHSS at presentation, large artery disease, supra tentorial, cortical location of infarct, use of anticoagulants, haemorrhagic transformation and hyponatraemia were significant risk factors of early seizures in acute ischaemic stroke. An early identification and understanding of these risk factors would help to prevent seizures in acute stroke patients.

Stroke Characteristics as Predictors of New-onset Seizure in Patients with Acute Ischemic Stroke.

The current guidelines on diagnosis and management of new-onset seizures in stroke are not well defined, especially in the Indian setting. Our study aims at providing insight into the hospital prevalence risk of new-onset seizures following ischemic stroke and to correlate seizure risk with the characteristics of stroke and other clinical parameters. A total of 127 patients were analyzed for the study where we assessed the clinical severity and the imaging severity of stroke using the National Institute of Health Stroke Scale (NIHSS) score and Alberta Stroke Program Early CT (ASPECT) score, respectively. Seizure-related variables including semiology, timing, and details of antiepileptic drugs (AEDs) were assessed under the domain of early and late poststroke seizures (PSSs). All patients were followed for 6 months for the seizure recurrence and change in Barthel index. In statistical analysis, quantitative variables were compared using the independent t-test/Mann-Whitney U test, and qualitative variables were correlated using Chi-square test/Fisher's exact test. Univariate and multivariate logistic regression was used to find out the significant risk factors of acute symptomatic seizure. The mean age of the study population was 59.72 years (±14.77), with a male predominance (60.63%). About 78.74% of the cases had an NIHSS score more than or equal to 6.24% had posterior circulation strokes and the rest had anterior circulation strokes. A cortical location of infarct was observed in 62.2% of cases and a subcortical location in 61.4% of cases. The prevalence of early PSSs observed in our study was 10.6%. Of those, 80% had generalized seizures, 13.3% had focal seizures, and 6.67% had focal seizures with secondary generalizations. No patient in the study group had late-onset seizures. Total leukocyte count, serum protein levels, serum uric acid levels, and erythrocyte sedimentation rate (ESR) values were associated with early seizures (p<0.05). Patients with early seizures were found to have a longer hospital stay (8 vs 6 days with p<0.05). In the Trial of Org 10,172 in Acute Stroke Treatment (TOAST) etiological classification, an acute stroke of undetermined etiology was found to have a significant association with the occurrence of early seizure in both univariate and multivariate analysis [p = 0.030; odds ratio (OR) 4.735 (1.160-22.576)]. There was no difference in change in the Barthel index among the two groups. There was no recurrence of seizures in those who defaulted for AED and one patient had a seizure even on AED. Prophylactic AEDs in stroke patients based on stroke characteristics could not be ascertained, but the sample size was small. Knowing the fact that antiepileptics cause sedation and increase the chance of aspiration, continuing AEDs in patients who develop acute symptomatic seizures should be judged judiciously.

Surgical decompression for malignant cerebral oedema after ischaemic stroke.

Large territory middle cerebral artery (MCA) ischaemic strokes account for around 10% of all ischaemic strokes and have a particularly devastating prognosis when associated with malignant oedema. Progressive cerebral oedema starts developing in the first 24 to 48 hours of stroke ictus with an associated rise in intracranial pressure. The rise in intracranial pressure may eventually overwhelm compensatory mechanisms leading to a cascading secondary damage to surrounding unaffected parenchyma. This downward spiral can rapidly progress to death or severe neurological disability. Early decompressive craniectomy to relieve intracranial pressure and associated tissue shift can help ameliorate this secondary damage and improve outcomes. Evidence has been accumulating of the benefit of early surgical decompression in stroke patients. Earlier studies have excluded people above the age of 60 due to associated poor outcomes; however, newer trials have included this patient subgroup. This review follows a Cochrane Review published in 2012. To assess the effectiveness of surgical decompression in people with malignant oedema after ischaemic stroke with regard to reduction in mortality and improved functional outcome. We also aimed to examine the adverse effects of surgical decompression in this patient cohort. We searched the Cochrane Stroke Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL; 2022, Issue 7 of 12), MEDLINE Ovid, Embase Ovid, Web of Science Core Collection, Scopus databases, ClinicalTrials.gov, and the WHO ICTRP to July 2022. We also reviewed the reference lists of relevant articles. We included randomised controlled trials (RCTs) comparing decompressive craniectomy with medical management to best medical management alone for people with malignant cerebral oedema after MCA ischaemic stroke. Two review authors independently screened the search results, assessed study eligibility, performed risk of bias assessment, and extracted the data. The primary outcomes were death and death or severe disability (modified Rankin Scale (mRS) > 4) at 6 to 12 months follow-up. Other outcomes included death or moderate disability (mRS > 3), severe disability (mRS = 5), and adverse events. We assessed the certainty of the evidence using the GRADE approach, categorising it as high, moderate, low, or very low. We included nine RCTs with a total of 513 participants included in the final analysis. Three studies included patients younger than 60 years of age; two trials accepted patients up to 80 years of age; and one trial only included patients 60 years or older. The majority of included trials (six) mandated a time from stroke ictus to treatment of < 48 hours, whilst in two of them this was < 96 hours. Surgical decompression was associated with a reduction in death (odds ratio (OR) 0.18, 95% confidence interval (CI) 0.12 to 0.27, 9 trials, 513 participants, P < 0.001; high-certainty evidence); death or severe disability (mRS > 4, OR 0.22, 95% CI 0.15 to 0.32, 9 trials, 513 participants, P < 0.001; high-certainty evidence); and death or moderate disability (mRS > 3, OR 0.34, 95% CI 0.22 to 0.52, 9 trials, 513 participants, P < 0.001; moderate-certainty evidence). Subgroup analysis did not reveal any significant effect on treatment outcomes when analysing age (< 60 years versus ≥ 60 years); time from stroke ictus to intervention (< 48 hours versus ≥ 48 hours); or dysphasia. There was a significant subgroup effect of time at follow-up (6 versus 12 months, P = 0.02) on death as well as death or severe disability (mRS > 4); however, the validity of this finding was affected by fewer participant numbers in the six-month follow-up subgroup. There was no consistent reporting of per-participant adverse event rates in any of the included studies, which prevented further analysis. Surgical decompression improves outcomes in the management of malignant oedema after acute ischaemic stroke, including a considerable reduction in death or severe disability (mRS > 4) and a reduction in death or moderate disability (mRS > 3). Whilst there is evidence that this positive treatment effect is present in patients > 60 years old, it is important to take into account that these patients have a poorer prospect of functional survival independent of this treatment effect. In interpreting these results it must also be considered that the data demonstrating benefit are drawn from a unique patient subset with profound neurological deficit, reduced level of consciousness, and no pre-morbid disability or severe comorbidity.

Author Response: Accuracy of CT Perfusion-Based Core Estimation of Follow-up Infarction: Effects of Time Since Last Known Well.

We appreciate the response to our article.1 Our study cohort was derived from consecutively enrolled patients at 9 high-volume EVT centers and did not exclude patients based on ischemic core estimates. The cohort reflects contemporary clinical practice with 25 patients with ischemic core ≥30 mL, 15 patients with ischemic core ≥50 mL, and 6 with ischemic core ≥70 mL. Rates of overestimation did not vary with core size (5/25, 3/15, and 1/6 with significant overestimation). Furthermore, only 1 patient in the cohort had an ischemic core estimate ≥70 mL and a final infarct volume of <70 mL. The findings are in line with previous studies that demonstrated 5%–7% patients have an ischemic core ≥70 mL, and <3% demonstrate overestimation that would render them ineligible for the EVT.2,3 Our analysis suggested that CT perfusion estimates correlate significantly with subsequent infarct volume, significant overestimation that affects potential EVT eligibility is infrequent, and the use of time-dependent ischemic core thresholds can alleviate the issue of potential undertreatment of these patients. In the light of CT ASPECTS issues with interrater reliability that may result in significant misclassification, even after training and underestimating the extent of ischemic injury in patients presenting very early after stroke ictus,4 perfusion imaging provides more reliable estimates of early ischemic injury. Clinical trials of thrombectomy efficacy and safety in patients with large core are ongoing. The SELECT2 study obtains both noncontrast CT (NCCT) and CT perfusion imaging and therefore will help establish if there is a ceiling to thrombectomy benefit in patients with large vessel occlusion based on NCCT or perfusion imaging findings.5

Predictors and Outcome of Early Post Stroke Seizures

Predictors and Outcome of Early Post Stroke Seizures

Poststroke Seizures and the Risk of Dementia Among Young Stroke Survivors.

The effect of new-onset seizures in young stroke survivors on the subsequent development of dementia is poorly understood. This study aimed to assess the association between new onset of seizure and dementia in a population-based study of patients with stroke. The IBM Watson Health MarketScan Commercial Claims and Encounters database for the years 2005-2014 served as the data source for this study. Using the International Classification of Diseases, Ninth Revision (ICD-9), we identified patients aged 18-60 years with ischemic strokes (ISs; 433.x1, 434.x1, and 436) and hemorrhagic strokes (HSs; 430, 431, 432.0, 432.1, and 432.9) between January 1, 2006, and December 31, 2009, which constituted our baseline study cohort. At baseline, all included participants were free of claims for dementia, brain tumors, toxin exposure, traumatic brain injury, and neuroinfectious diseases, identified using ICD-9 codes. They had at least 1-year continuous enrollment before the index stroke diagnosis and 5 years after, with no seizure claims within 1 year after the index date. The exposure of interest was seizures: a time-dependent variable. The study outcome of interest was dementia (ICD-9: 290.0, 290.10-13, 290.20-21, 290.3, 290.40-43, 291.2, 292.82, 294.10-11, 294.20-21, 294.8, 331.0, 331.11, 331.19, and 331.82), which occurred during the follow-up period from January 1, 2010, to December 31, 2014. A Cox proportional hazards regression model was applied to calculate the hazard ratio (HR) and 95% CI for the independent association of seizures with the occurrence of dementia. At the end of the baseline period, we identified 23,680 patients with stroke (IS: 20,642 and HS: 3,038). The cumulative incidence of seizure was 6.7%, 6.4%, and 8.3% for all strokes, IS, and HS, respectively. The cumulative incidence of dementia was 1.3%, 1.4%, and 0.9% for all strokes, IS, and HS, respectively. After multivariable adjustment, young patients with stroke who developed seizures had a greater risk of dementia compared with those without seizures (all strokes adjusted HR: 2.53, 95% CI 1.84-3.48; IS: 2.52, 1.79-3.53; HS: 2.80, 1.05-7.43). These findings suggest that the onset of seizures in young stroke survivors is associated with a 2.53 times increased risk of developing dementia. This study provides Class II evidence that poststroke seizures increase the probability of dementia in young stroke survivors.

Early seizures in stroke - frequency, risk factors, and effect on patient outcomes in a tertiary center in Saudi Arabia.

Objectives:To determine the frequency, risk factors, and outcomes of Early seizure (ES) after stroke in a Saudi cohort.Methods:A retrospective study was conducted in King Abdulaziz Medical City, Riyadh, KSA. All stroke patients whether they had first or recurrent stroke were included from February 2016 to December 2017. Data were analyzed using the SAS software version 9.4.Results:Out of 665 patients, 456 (68.6%) were males and 564 (85.2%) were Saudis; the cohort’s mean age was 60.6±12.6 years. Fifty-one (7.7%) patients had ES, which were more common in women (p=0.0123). Loss of consciousness (p=0.0402) and confusion (<0.0007) were associated with ES, whereas unilateral weakness (p=0.001) and unilateral numbness (p=0.0317) at presentation decreased the risk of ES. Vascular risk factors did not differ between patients with and without ES. Hemorrhagic stroke was associated with ES (p=0.0054), whereas patients with small vessel disease were less likely to develop ES (p=0.0013). Patients with ES had more severe stroke (NIHSS >5) (p=0.0139), more ICU admissions (49% vs. 26.2%; p=0.0005), longer length of hospital stay (44.9 days vs. 24.9 days; p=0.0018), higher rates of stroke-related complications (e.g. recurrent stroke, pulmonary embolism, hospital acquired infections, and need for tracheostomy and gastrostomy tube placement) (p≤0.0001), and were likely to be more severely disabled defined as mRS 3–5 at discharge (47.7% vs. 40.8%; p=0.0055) or to die in hospital (11.8% vs. 4.6%; p≤0.0001).Conclusion:The ES after stroke were common in our cohort. Increased stroke severity and confusion were independent predictors of ES. The ES were associated with higher rates of in-hospital complications, longer length of hospital stay, and worse outcomes at discharge.

Early-onset seizures in ischemic stroke: A descriptive cross-sectional study

Context: Poststroke seizures are not infrequent neurological sequelae of stroke. Aims: The primary aim of our study is to determine the frequency of early seizures in acute ischemic stroke in our population. Subjects and Methods: It is a descriptive cross-sectional study done at the Department of Neurology, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Pakistan. The duration of the study was of 6 months, from July 2019 to December 2019. All patients who fulfilled the inclusion criteria were enrolled in the study after Institutional Review Board approval. Informed and written consent was obtained from all subjects. A detailed history and clinical examination were carried out and all patients were assessed by a trained neurologist. Results: Total 281 patients with ischemic stroke were included. One hundred and eighty-one patients (64.4%) were male and 100 (35.6%) were female with a mean age of 48.41 ± 8.730 years. The early-onset seizures were noted in 22 patients (7.8%). In our study, early-onset poststroke seizures were noted more commonly in the age group of 36–60 years and were predominant in the males. Patients with infarction in the parietal lobe exhibited greater seizure occurrence. The most common seizure type observed was generalized tonic–clonic. Majority of early-onset poststroke seizures occurred in the 1st week. Conclusion: In our study, the frequency of early onset seizures in patients with ischemic stroke was found to be 7.8%, which when occurs increases morbidity.

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

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.

Post Ischemic Stroke Seizures: Prevalence, Predictive Factors and Cortical Involvement

Post Ischemic Stroke Seizures: Prevalence, Predictive Factors and Cortical Involvement

Electroencephalogram (EEG) Features of Post-Stroke Seizure Patients in the Department of Neurology, Dr. Soetomo General Hospital Surabaya

Backgrounds: Seizures are one of the most common and hazardous neurological complications of stroke. Post-stroke seizures were classified as early onset seizure and late onset seizure, depending on seizure onset after stroke. Stroke is one of the most common risk factors for seizures and epilepsy, especially in older patients, accounting for 39-45% of all seizure incidents. Knowledge of various risk factors and capability to perform supporting examinations such as EEG are essential to do with the aim of early detection, improving the prevention and treatment of post-stroke seizures so that it is expected to reduce the prevalence and mortality rate of post-stroke seizures. Objectives: This study aims to determine the electroencephalogram (EEG) features found in post-stroke seizure patients in the Department of Neurology, Dr. Soetomo Surabaya Hospital Methods: This study is a descriptive observational study using secondary data obtained from the medical records of patients with post-stroke seizures at the Department of Neurology, Dr. Soetomo Surabaya Hospital within the time period of January 2017 ? December 2019. Results: In this research, we evaluated seizure characteristics in 230 patients who had ischemic and hemorrhagic stroke. 116 patients were male (50.4%) while 114 patients were female (49.6%). The highest age range found in the study sample was > 19-60 years. In addition, this study revealed that 58.7% of seizures were focal seizures and 39.1% were generalized seizures, the remaining 2.2% were unknown seizures. Focal seizures become bilateral tonic clonic seizures are the most common type of focal seizures while generalized tonic clonic seizures are the most common type of generalized seizures seen. 80% of patients with focal seizures have impaired awareness during seizures. Seizures occurred in 148 ischemic stroke patients (64.3%) and 82 hemorrhagic stroke patients (35.7%). 97 Patients with ischemic stroke had thrombus etiology (65. 5%) and 32 had an embolic etiology (21.6 %), while patients with hemorrhagic stroke had the most dominant etiology, namely ICH as many as 53 patients (64.6%). lesions were cortical (47.8%) and 91 patients had lesions located subcortical (39.6%). The majority of patients experienced early onset seizures (55.2%) and the majority of patients had EEG recordings 7 - < 14 days and 3 - < 7 days after seizure manifestations (29.1%). EEG results showed abnormal features in 78.7% patients. Slow activity EEG is the most visible EEG picture with Continuous Slow Activity (CSA) as the most dominant pattern, while in epileptiform EEG the sharp/spike wave image is the most common pattern. In the EEG special pattern, the most common picture is asymmetry decreased background rhythm accompanied by CSA. Conclusion: This hospital-based study showed that post-stroke seizures were associated with young and middle aged (>19-60 years), male gender, ischemic stroke, thrombus type, cortical location, and comorbid hypertension, with a high prevalence rate in patients with hypertension. Based on this study, our data showed that patients with post-stroke seizures after stroke were more likely to have impaired awareness during the seizure. The most EEG features found in this study are continuous slow activity waves. In this study, post stroke seizures occurred more commonly after ischemic stroke, middle aged, and when stroke occurred in the cortical region

Prevalence of Patent Foramen Ovale in a Cohort of Children With Cryptogenic Ischemic Stroke.

To determine the significance of patent foramen ovale (PFO) in childhood stroke, we compared PFO prevalence, PFO features, and stroke recurrence risk in 25 children with cryptogenic arterial ischemic stroke (AIS), 54 children with AIS from a known etiology, and 209 healthy controls. We performed a case-control analysis of a 14-year prospectively enrolled single-center cohort of children with AIS who underwent transthoracic echocardiogram (TTE) and compared them to TTEs of otherwise healthy children evaluated for benign cardiac concerns. Stroke patients 29 days to 18 years of age at stroke ictus with confirmed acute AIS on imaging, availability of complete diagnostic studies of stroke risk factors, including TTE images available for central review, and at least 1 follow-up evaluation after index stroke were included. Presence of PFO and high-risk PFO features were assessed by 2 independent, blinded reviewers and compared between groups with the Fisher exact test. Stroke/TIA recurrence risk was determined from Cox proportional hazards models. Of 154 children with first-ever AIS, 79 were eligible; 25 had cryptogenic AIS, and 54 had a known cause. PFO prevalence was higher in the cryptogenic group (7, 28%) compared to both the known stroke etiology group (3, 5.6%, p = 0.009) and controls without stroke (24, 11.5%, p = 0.03). There were no significant differences in presence of right-to-left shunt and atrial septal aneurysm. Median follow-up time for entire stroke cohort was 20.9 months. Stroke-free recurrence at 2-years did not differ between children with and without PFO (HR 2.0, 95% CI 0.4-9.3, p = 0.39). PFO prevalence was higher in children with cryptogenic stroke compared to patients with AIS with known etiology and healthy controls. PFO was not associated with increased recurrence risk. Optimal secondary preventive treatment in children with cryptogenic stroke and PFO remains uncertain and requires further study. This study provides Class III evidence that children with cryptogenic ischemic stroke have an increased frequency of PFO compared to children with ischemic stroke of known etiology and healthy controls.

Early and late seizures in malignant middle cerebral artery stroke treated with decompressive craniectomy and: Preliminary results of a single center registry

More than 40% of patients with malignant middle cerebral artery (MCA) stroke undergone craniectomy may develop both early or late seizures, mainly partial with generalization. The median onset of seizures was seven months; delayed craniectomy (>42 h) has been identified as a risk factor for seizure (1, 2). The aim of our study was to identify factors related to the occurrence of seizures.