Seizure After Ischemic Stroke; A Diagnostic and Management Challenge in a Resource Limited Setting: A Case Report
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Abstract
Background: Poststroke seizures occur in 6-8% of the adult population that suffer an ischaemic stroke. This pathological process increases metabolic stress and cell death, the extent of vascular obstruction in the brain, the mortality rate and long term morbidity. Poststroke seizures represent one of the most important complications of stroke that must be recognised and treated in a timely fashion. These are classified as either early or late depending on the time of onset after stroke.
Case Report: A 51 year old woman presented to the Emergency Department of RSUD Dr Murjani following a generalised tonic-clonic seizure 3 hours prior that had lasted for two minutes. On arrival the patient subsequently had two further generalised tonic-clonic seizures with a one hour interval between. Whole body stiffness and a fixed upward gaze were observed. A non-contrast CT Head displayed a diffuse infarct of the left frontotemporoparietooccipital lobes. The patient had a history of stroke one year previously and a second stroke one month ago with resultant persistent weakness of the right upper and lower limbs. This patient was diagnosed with poststroke seizure of late onset and treated in hospital with diazepam 10mg and phenytoin 100mg three times per day.
Discussion: Poststroke seizure is described as either early-onset (occurring in the first week after a stroke) or late-onset (occurring after the first week). Based on the International League Against Epilepsy (ILAE) definition, a single unprovoked late-onset poststroke seizure occurring more than seven days after a stroke is considered as epilepsy with a high risk (>60%) of recurrent seizures that may occur for up to ten years thereafter. Hence this risk factor must be identified and treated correctly to prevent significantly increased morbidity for the patient
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References
I. Chen Z, Churilov L, Chen Z, Naylor J, Koome M, Yan B, et al. Association between implementation of a code stroke system and poststroke epilepsy. Neurology. 2018 Mar 27;90(13):e1126–33.
II. Gadama YG, Mwangalika G, Kinley LB, Jackson B, Mwandumba HC, Mallewa J, et al. Challenges of stroke management in resource-limited settings: A case-based reflection. Malawi Med J. 2017 Jun;29(2):189–93.
III. Xu MY. Poststroke seizure: optimising its management. Stroke Vasc Neurol [Internet]. 2019 Mar 1 [cited 2022 Nov 15];4(1). Available from: https://svn.bmj.com/content/4/1/48
IV. Chen Z, Churilov L, Koome M, Chen Z, Naylor J, Kwan P, et al. Post-Stroke Seizures Is Associated with Low Alberta Stroke Program Early CT Score. Cerebrovasc Dis Basel Switz. 2017;43(5–6):259–65.
V. Goldstein LB, Samsa GP. Reliability of the National Institutes of Health Stroke Scale. Stroke. 1997;28(2):307-10.
VI. Lin R, Yu Y, Wang Y, Foster E, Kwan P, Lin M, et al. Risk of Post-stroke Epilepsy Following Stroke-Associated Acute Symptomatic Seizures. Front Aging Neurosci. 2021 Sep 13;13:707732.
VII. Brondani R, de Almeida AG, Cherubini PA, Secchi TL, de Oliveira MA, Martins SCO, et al. Risk Factors for Epilepsy After Thrombolysis for Ischemic Stroke: A Cohort Study. Front Neurol [Internet]. 2020 [cited 2022 Nov 15];10. Available from: https://www.frontiersin.org/articles/10.3389/fneur.2019.01256
VIII. Ferreira-Atuesta C, Döhler N, Erdélyi-Canavese B, Felbecker A, Siebel P, Scherrer N, et al. Seizures after Ischemic Stroke: A Matched Multicenter Study. Ann Neurol. 2021 Nov;90(5):808–20.
IX. Alsaad F, Alkeneetir N, Almatroudi M, Alatawi A, Alotaibi A, Aldibasi O, et al. Early seizures in stroke - frequency, risk factors, and effect on patient outcomes in a tertiary center in Saudi Arabia. Neurosci Riyadh Saudi Arab. 2022 Apr;27(2):104–10.
X. Scoppettuolo P, Gaspard N, Depondt C, Legros B, Ligot N, Naeije G. Epileptic activity in neurological deterioration after ischemic stroke, a continuous EEG study. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. 2019 Dec;130(12):2282–6.
XI. Galovic M, Ferreira-Atuesta C, Abraira L, Döhler N, Sinka L, Brigo F, et al. Seizures and Epilepsy After Stroke: Epidemiology, Biomarkers and Management. Drugs Aging. 2021 Apr;38(4):285–99.
XII. Galovic M, Döhler N, Erdélyi-Canavese B, Felbecker A, Siebel P, Conrad J, et al. Prediction of late seizures after ischaemic stroke with a novel prognostic model (the SeLECT score): a multivariable prediction model development and validation study. The Lancet Neurology. 2018;17:143-52.