Background and Purpose: Studies on post-stroke seizures have produced conflicting results. Our study aim was to further elucidate the incidence and predictive factors of early post-stroke seizures (ES) and their relationship with outcome. Methods: relevant clinical data were prospectively collected in 2,053 patients with acute stroke admitted to the Stroke Unit from 2004 to 2008. Results: Sixty-six patients (8 hemorrhagic and 58 ischemic strokes) aged 73–88 years (mean age 82 years) presented seizures in the first week after stroke onset. The type of ischemic stroke was atherothrombotic in 10 patients, cardioembolic in 21, lacunar in 4, undetermined in 19, and of other etiology in 4. Twenty-seven patients had generalized convulsive, 6 had complex partial, and 33 had simple partial seizures. Status epilepticus was observed in 13 patients. The severity of strokes in patients with ES was greater than in those without (National Institutes of Health Stroke Scale >14 in 50 vs. 25%), so mortality (30 days) was higher (29 vs. 14%). Independent seizure predictors were: total anterior circulation infarct, hemorrhagic transformation, hyperglycemia, and the interaction term diabetes × hyperglycemia. Conclusions: ES may be considered a marker of stroke severity. Cortical location of the lesion, hemorrhagic transformation, and hyperglycemia in patients without diabetes are important predictors of ES.

Myoclonus has been reported as a possible manifestation of coronavirus disease 2019 (COVID-19), yet its neurophysiology and pathogenesis were poorly investigated. 1-4 We describe a middleaged man with COVID-19 who underwent extensive examinations for his disabling myoclonus. CASE REPORT A 58-year-old hypertensive man with a 1-week history of fever and cough presented to the emergency department with dyspnea. A nasopharyngeal swab tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The patient was admitted to the intensive care unit after 1 week and placed on invasive mechanical ventilation as a result of respiratory distress. He was treated with hydroxychloroquine, tocilizumab, and remdesivir. Respiratory status quickly improved, thus he was extubated after 5 days, and oxygen therapy was progressively weaned off. Two days after discharge from the intensive care unit, he became markedly agitated. His mental status normalized in 48 hours; however, at this point he developed multifocal myoclonus elicited by action and tactile stimuli, predominant in the right proximal inferior limb muscles, preventing his ability to stand (Video SS1). Cognitive deficits were not observed. Electrolytes and renal and liver function tests were unremarkable. Cerebrospinal fluid (CSF) analysis, performed 8 days after myoclonus onset, demonstrated 5 leukocytes/μL, elevated protein levels (75 mg/dL) and CSF/serum albumin ratio (13.1), and negative SARS-CoV-2 reverse-transcription polymerase chain reaction. Cytokine analyses revealed interleukin-6 at 11.6 pg/mL in CSF (29.3 pg/mL in serum, reference < 5.9) and interleukin-8 at 38 pg/ mL in CSF (11 pg/mL in serum, reference < 70). A serologic panel