Seizures during stroke thrombolysis heralding dramatic neurologic recovery.
Seizures during thrombolytic therapy for ischemic stroke have not previously been described as a favorable prognostic sign. We report three patients with severe stroke (NIH Stroke Scale [NIHSS] score 15 to 20) who experienced a seizure during tissue plasminogen activator (tPA) infusion. While initially raising alarm about possible hemorrhage, the seizures heralded dramatic recovery (an immediate 15-point NIHSS score improvement after tPA; NIHSS score 0 or 1 at 24 hours). We propose that the seizures during thrombolysis may indicate cortical reperfusion and/or hyperperfusion due to early recanalization of an acutely occluded intracranial artery.
Rodan
L H
LH
North and East GTA Regional Stroke Centre, Division of Neurology, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Aviv
R I
RI
Sahlas
D J
DJ
Murray
B J
BJ
Gladstone
J P
JP
Gladstone
D J
DJ
D000328:Adult; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology; D012640:Seizures / Q000139:chemically induced / Q000503:physiopathology*; D020521:Stroke / Q000188:drug therapy* / Q000503:physiopathology*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects
D010959:Tissue Plasminogen Activator