Seizure at stroke onset: should it be an absolute contraindication to thrombolysis?
BACKGROUND
Current guidelines for the treatment of acute ischemic stroke exclude patients with seizure at stroke onset from consideration for thrombolytic therapy. It may be difficult to differentiate an ischemic stroke from postictal Todd's paralysis by clinical examination and noncontrast CT scan. Magnetic resonance imaging (MRI) with diffusion- (DWI) and perfusion-weighted images (PWI) and angiography (MRA) can be used to confirm the diagnosis of an acute ischemic process in the presence of concurrent seizures.


METHODS
A case report of a patient who presented with seizures, in whom the combination of DWI/PWI MRI and MRA confirmed the diagnosis of an embolic ischemic stroke. The patient was treated with intravenous recombinant tissue plasminogen activator with clinical and radiological improvement.


CONCLUSIONS
Treatment decisions with regard to thrombolysis in acute stroke patients should be based on parameters of cerebral perfusion, assessment of collateral blood flow and presence of potentially salvageable tissue. Modern neuroimaging techniques that can rapidly assess these variables, such as DWI/PWI MRI and MRA, can improve the current selection of patients who are likely to benefit from thrombolysis and extend its benefit to patients who would otherwise be excluded, such as those with seizures at stroke onset.
Selim
Magdy
M
Department of Neurology, Division of Cerebrovascular Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA. selimm@ummhc.org
Kumar
Sandeep
S
Fink
John
J
Schlaug
Gottfried
G
Caplan
Louis R
LR
Linfante
Italo
I
D000368:Aged; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D011859:Radiography; D012640:Seizures / Q000150:complications* / Q000000981:diagnostic imaging; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D010959:Tissue Plasminogen Activator