Magnetic resonance imaging after seizures in patients with an ischemic stroke.
BACKGROUND
Seizures related to ischemic strokes are harmful. Their pathogenesis is not very well understood. The present study investigates whether diffusion-weighted imaging (DWI) can detect if those seizures are due to recurrent infarction or responsible for secondary ischemic changes.


METHODS
DWI was obtained within 8 days in 60 patients with seizures (7 early and 53 late onset) related to an ischemic stroke.


RESULTS
In 30 patients, positive DWI with decreased apparent diffusion coefficient was found. In 11 patients with late-onset seizures, the DWI showed a positive rim, surrounding the old infarct, while in 12 patients a large positive zone corresponding to a new infarct was observed. All 7 patients with early-onset seizures had positive DWI corresponding to the establishing infarct. A large positive zone on DWI was mainly observed in cardioembolic stroke.


CONCLUSIONS
The positive rim around the old infarct can be considered as cytotoxic edema. Recurrent acute infarction, mainly of cardioembolic origin, seems to be a significant cause of so-called late-onset seizures, making the subdivision into early- and late-onset seizures arbitrary.
De Reuck
J
J
Stroke Unit, Department of Neurology, University Hospital Ghent, Ghent, Belgium. jacques.dereuck@gmail.com
Vanhee
F
F
Van Maele
G
G
Claeys
I
I
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D012640:Seizures / Q000209:etiology* / Q000473:pathology; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D013997:Time Factors