Ramiro Castro-Apolo1, Josephine F Huang2, Myrian Vinan-Vega3, William O Tatum4. 1. Department of Neurology, Mayo Clinic, Jacksonville, FL, USA; Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA. 2. Department of Neurology, Mayo Clinic, Jacksonville, FL, USA. 3. Department of Neurology, Mayo Clinic, Jacksonville, FL, USA; Department of Internal Medicine, Texas Tech University, Lubbock, TX, USA. 4. Department of Neurology, Mayo Clinic, Jacksonville, FL, USA. Electronic address: tatum.william@mayo.edu.
Abstract
PURPOSE: To evaluate clinical, radiographic, and electrophysiological features in the development and prognosis of ischemic post-stroke seizures (PSS). METHOD: A retrospective study of 1119 patient records was performed between January 2006 and December 2016. After selection, 42 patients with seizures due to ischemic stroke were matched to a control group of 60 patients where seizures were absent. Stroke size and severity were analyzed using ASPECTS and NIHSS, respectively. Hemorrhagic transformation graded by ECASS III classification. Outcomes were assessed using the modified Rankin Scale. Fisher's exact test assessed categorical variables, and Mann-Whitney tested continuous variables. RESULTS: Forty-two patients experienced PSS (22 females; median age 72.5 years) and were matched with 60 control subjects that had ischemic stroke without seizures. Focal seizures were present in 42.9% (18/42), and focal to bilateral convulsions in 57.1% (24/42). Stroke localization and severity did not differ (p = 0.6 and 0.21, respectively). Stroke size in anterior circulation was larger in PSS patients (median ASPECTS 6 vs 8 [p = 0.01]). Posterior circulation stroke size was similar in both groups. The presence of hemorrhage was the primary risk factor for PSS (61.9%) compared to controls (36.7%), p = 0.01. The presence of laminar necrosis (LN) (47.6% vs 21.6%, p = 0.005) and hemosiderin deposition (38.1% vs 18.3%, p = 0.02) were most predictive. PSS patients demonstrated worse outcomes than the controls (median mRS 3 vs 2, [p=<0.001]) with a median follow up of 14.8 and 20.7 months, respectively. CONCLUSIONS: The size of anterior infarction, presence of blood products within the infarct bed, and especially LN predicted PSS.
PURPOSE: To evaluate clinical, radiographic, and electrophysiological features in the development and prognosis of ischemic post-stroke seizures (PSS). METHOD: A retrospective study of 1119 patient records was performed between January 2006 and December 2016. After selection, 42 patients with seizures due to ischemic stroke were matched to a control group of 60 patients where seizures were absent. Stroke size and severity were analyzed using ASPECTS and NIHSS, respectively. Hemorrhagic transformation graded by ECASS III classification. Outcomes were assessed using the modified Rankin Scale. Fisher's exact test assessed categorical variables, and Mann-Whitney tested continuous variables. RESULTS: Forty-two patients experienced PSS (22 females; median age 72.5 years) and were matched with 60 control subjects that had ischemic stroke without seizures. Focal seizures were present in 42.9% (18/42), and focal to bilateral convulsions in 57.1% (24/42). Stroke localization and severity did not differ (p = 0.6 and 0.21, respectively). Stroke size in anterior circulation was larger in PSSpatients (median ASPECTS 6 vs 8 [p = 0.01]). Posterior circulation stroke size was similar in both groups. The presence of hemorrhage was the primary risk factor for PSS (61.9%) compared to controls (36.7%), p = 0.01. The presence of laminar necrosis (LN) (47.6% vs 21.6%, p = 0.005) and hemosiderin deposition (38.1% vs 18.3%, p = 0.02) were most predictive. PSSpatients demonstrated worse outcomes than the controls (median mRS 3 vs 2, [p=<0.001]) with a median follow up of 14.8 and 20.7 months, respectively. CONCLUSIONS: The size of anterior infarction, presence of blood products within the infarct bed, and especially LN predicted PSS.
Authors: Johann Philipp Zöllner; Björn Misselwitz; Thomas Mauroschat; Christian Roth; Helmuth Steinmetz; Felix Rosenow; Adam Strzelczyk Journal: Sci Rep Date: 2020-12-03 Impact factor: 4.379
Authors: Johann Philipp Zöllner; Friedhelm C Schmitt; Felix Rosenow; Konstantin Kohlhase; Alexander Seiler; Adam Strzelczyk; Hermann Stefan Journal: Neurol Res Pract Date: 2021-12-06