title: Seizures during stroke thrombolysis heralding dramatic neurologic recovery.
abstract: 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.
authors.affiliation: North and East GTA Regional Stroke Centre, Division of Neurology, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: L H
authors.initials: LH
authors.lastname: Rodan
authors.forename: R I
authors.initials: RI
authors.lastname: Aviv
authors.forename: D J
authors.initials: DJ
authors.lastname: Sahlas
authors.forename: B J
authors.initials: BJ
authors.lastname: Murray
authors.forename: J P
authors.initials: JP
authors.lastname: Gladstone
authors.forename: D J
authors.initials: DJ
authors.lastname: Gladstone
mesh_terms: 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
chemical_list: D010959:Tissue Plasminogen Activator