Persistent worsening of stroke sequelae after delayed seizures
J. Bogousslavsky, R. Martin, F. Regli, P. A. Despland and S. Bolyn
Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Though the role of cerebral ischemia as an etiologic factor for epilepsy is
accepted, the effect of seizures on stroke sequelae has received little
attention. We describe 10 patients with poststroke partial epileptic
seizures that were followed by persistent worsening of the previous
neurologic deficit. Of 38 other patients with poststroke seizures who were
examined during the same period, eight suffered transient neurologic
worsening (Todd's phenomenon). Persistent worsening was associated with
longer seizures and longer partial seizures before generalization. Risk
factors, age, sex, other seizure features, and characteristics of previous
stroke were irrelevant to developing persistent worsening of stroke
sequelae. None of the patients with persistent worsening showed a new
lesion or an extension of the previous ischemic area on computed tomography
or magnetic resonance imaging, except one who had a first hemorrhage that
spared the cortex and who suffered a second hemorrhage, which was lobar.
Persistent worsening of a neurologic deficit following a seizure in
patients with previous stroke may not be uncommon and may be due to a
direct effect of the seizure itself on the infarcted area.
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