Reperfusion seizures: a manifestation of cerebral reperfusion injury after administration of recombinant tissue plasminogen activator for acute ischemic stroke.
Reperfusion injury has been well described in medical literature; cerebral reperfusion injury is commonly seen in association with vascular surgical procedures such as carotid endarterectomies and stent placement procedures. Cerebral reperfusion injury can manifest as blood-brain barrier breakdown, cortical irritability, and epileptic seizures. Seizures induced by cerebral reperfusion have not been documented or reported after thrombolytic therapy for acute ischemic stroke. We report a patient who received intravenous recombinant tissue plasminogen activator within 3 hours of stroke symptom onset and developed the new-onset symptom of continuous, primary motor seizure activity within 20 minutes of recombinant tissue plasminogen activator administration. These epileptic seizures originated in the same area as the acute brain ischemia and occurred during the anticipated period of cerebral reperfusion. In this article we describe a case report and then discuss the pathophysiology and mechanisms that may underlie reperfusion epileptic seizures as a manifestation of cerebral reperfusion injury.
University of Toledo Stroke Program, Department of Neurology, University of Toledo Medical Center, Ohio 43614, USA.
Faizan
F
Hafeez
Mohammad A
MA
Razzaq
Ross L
RL
Levine
Mark Allan N
MA
Ramirez
D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D002545:Brain Ischemia / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D004569:Electroencephalography; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous; D008140:Lorazepam / Q000627:therapeutic use; D008297:Male; D010672:Phenytoin / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000009:adverse effects; D015427:Reperfusion Injury / Q000139:chemically induced* / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D012640:Seizures / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome
D000927:Anticonvulsants; D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010672:Phenytoin; D010959:Tissue Plasminogen Activator; D008140:Lorazepam