STROKE

OVERVIEW

Stroke includes two main types, hemorrhagic and ischemic. Both types of stroke can cause acute seizures at the time of the acute event, as well as epilepsy as a long-term complication. In the elderly, cerebrovascular disease and stroke are the most common cause of acute seizures and epilepsy.

Clinical context

The clinical presentation of stroke depends on the extent and location of the haemorrhage and/or ischemia, age, and underlying cause. Acute seizures typically occur in the first 24 hours of the stroke. Acute management centers both on management of seizures, and also management of the stroke. If epilepsy occurs as a post-stroke complication, there is typically a latent period, and then re-emergence of seizures 6-12 months following the stroke. Cognitive and neurological impairments may occur as a consequence of the stroke.

Congenital stroke

Stroke may occur prenatally or perinatally, with middle cerebral artery distribution stroke being common due to the nature of stroke etiologies in this age group. Infants may present with hemiplegia, which may only be diagnosed as development progresses and asymmetric motor function is recognized, such as early hand preference. Seizures may be the presenting symptom, and may have onset in the neonatal period or later. Because of the middle cerebral artery territory involvement, seizures with focal features that relate to sensori-motor cortex occur. Epileptic spasms occur in around one third of patients, generally responding to medication.

CAUTION developmental and cognitive outcome may be worse in children with uncontrolled seizures in early life, especially if epileptic spasms or generalized seizure types appear, therefore proactive seizure control is important, this may include epilepsy surgery if seizures are not controlled with medication.