Can seizures be the only manifestation of transient ischemic attacks? A report of four cases

Abstract

Several studies have investigated the frequency of epileptic seizures following ischemic strokes and transient ischemic attacks (TIAs). Little attention has been paid to the possibility that seizures may be precipitated by TIAs. We examined if seizures can be the only symptom of a TIA and how often this might occur. We performed a retrospective analysis of clinical charts and electroencephalograms of 160 consecutive patients evaluated for a first-ever seizure from January 1997 to December 1999 at Belluno General Hospital. From January to May 2000, 19 more first-ever seizure patients were evaluated directly. Four patients (2%) had seizures in the presence of important risk factors for ischemic stroke (atrial fibrillation in two patients, atrial fibrillation and ventricular mural thrombus in one patient, hemodynamically significant left carotid stenosis in one patient). Seizures were not accompanied by other neurological deficits or brain lesions on CT or MRI. As risk factors for brain ischemia are frequent in the general population not developing seizures, our results do not prove that the occurrence of seizures was more than casual in these patients. Yet they indicate that in a small percentage of patients, seizures can occur in a context highly suggestive of TIA, with no other focal deficits.

Delayed Transient Worsening of Neurological Deficits after Ischaemic Stroke

“…Inhibitory seizures resembling TIAs have occasionally been described [40,41,42,43]. The literature on inhibitory seizures after stroke is even scarcer [44, 45].…”

A patient with atonic seizures mimicking transient ischemic attacks

“…Because focal epilepsy has been reported as a possible manifestation of a transient ischemic attack [7] , [8] , we should consider in this case the possibilities that either the monolimb weakness was the manifestation of a negative seizure provoked by a transient ischemic attack or a newly developed transient ischemic attack provoked the excitation of the left temporal area and the cascade hypothesized above. These events may have been precipitated by the lesion in the superior parietal lobe [9] , which presented as transient monolimb weakness in our case.…”

The use of neurovascular imaging for triaging tia and minor stroke: Implications for therapy

“…minor stroke population. The clinical diagnosis of TIA and minor stroke is not always straightforward because even sudden focal neurologic symptoms may have nonischemic etiologies (stroke mimics) such as anxiety or somatization [9], seizures [10,11], syncope [11], migraine [12], sepsis [11], subdural hematoma [13], and cancer [14]. These nonischemic mimics are often misdiagnosed as stroke by non-neurologists [15].…”