title: Seizure at stroke onset: should it be an absolute contraindication to thrombolysis?
abstract: 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.
authors.affiliation: Department of Neurology, Division of Cerebrovascular Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA. selimm@ummhc.org
authors.forename: Magdy
authors.initials: M
authors.lastname: Selim
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kumar
authors.forename: John
authors.initials: J
authors.lastname: Fink
authors.forename: Gottfried
authors.initials: G
authors.lastname: Schlaug
authors.forename: Louis R
authors.initials: LR
authors.lastname: Caplan
authors.forename: Italo
authors.initials: I
authors.lastname: Linfante
mesh_terms: 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
chemical_list: D010959:Tissue Plasminogen Activator