Computed tomographic changes of the brain and clinical outcome of patients with seizures and epilepsy after an ischaemic hemispheric stroke

Abstract

It is not well established whether seizures and epilepsy after an ischaemic stroke increase the disability of patients. Seventy-two patients with delayed seizures after a hemispheric infarct (37 with a single seizure and 35 with epilepsy) were included in the study. The modified Rankin scale was used to compare disability of the patients at 1 month after stroke and at 2 weeks after single or the last seizure, in case of epilepsy. The size of the X-ray hypoattenuation zone was compared on computed tomographic (CT) scans, performed in the weeks after the stroke and 1 week after single or repeated seizures. Lesion size was determined by superimposing the CT slices on digital cerebral vascular maps, on which the contours of the infarct area were delineated. The extent of the infarcts was expressed as the percentage fraction of the total surface area of the cerebral hemisphere. Groups with a single seizure and with epilepsy were mutually compared. Infarcts predominated in the parieto-temporal cortical regions. In the overall group the median Rankin score worsened significantly after seizures. The average size of the X-ray hypoattenuation zone was also significantly increased on the CT scans after the seizures, compared with those after stroke, without clear evidence of recent infarction. Mutual comparison of patients with a single seizure episode and of those with epilepsy showed only a trend of more severe disability and of increase in lesion size in the post-stroke epilepsy group. Delayed seizures and epilepsy after ischaemic stroke are accompanied by an increase in lesion size on CT and by worsening of the disability of the patients. This study does not allow to determine whether this is due to stroke recurrence or due to additional damage as a result of the seizures themselves.

Evaluation of the efficacy of sodium valproate in convulsive status epilepticus following to ıschemic stroke

“…Rankin scale is very important in the assessment of disability in patients with stroke 11 . Our patients' outcome average mRS had increased in a similar manner to that reported in previous studies 3,4 . In addition, we found that the patients with high mRS did not adequately respond to IV SV treatment, and the development of RSE occurred more frequently in these patients; those patients with low mRS responded far better to this treatment.…”

Characteristics and Outcomes of Patients with Seizures according to the Time of Onset in Relation to Stroke

“…Although it is found to occur only in 3.4% within 1 year after stroke in Chinese patients [11], studies pursuing a longer time course found that approximately 50% who had a first epileptic spell develop epilepsy [5,12,13,14,15]. The only clinical predictor for the development of LS after ischaemic stroke is the presence of a partial anterior circulation syndrome.…”

Cognitive Impairment and Seizures in Patients with Lacunar Strokes

“…29 on the other hand, severe seizures or status epilepticus, induces additional cytotoxic oedema around the infarct on MRi, 30 leading to increase in the infarct size and a worse outcome. 31 in our series a history of seizures was found in 15 % of patients with lacunar strokes. The National institutes of health Stroke Scale score at stroke onset was on average 3.7 in the seizure patients and 5.5 in the non-seizure ones, with an independence rate at 1 year on modified Rankin of 55 % in the former and of 73 % in the latter group.…”