Status epilepticus mimicking stroke recurrence

Area of Science:

• Neurology
• Epileptology
• Stroke Medicine

Background:

• Previous stroke increases the risk of developing neurological complications.
• Status epilepticus (SE) can present with symptoms that mimic acute stroke events.
• Differentiating SE from stroke recurrence is critical for appropriate management.

Purpose of the Study:

• To evaluate the clinical characteristics of patients with previous stroke who develop SE that mimics a stroke relapse.
• To compare the clinical features and outcomes of patients with SE mimicking stroke versus those with true stroke relapse.

Main Methods:

• Retrospective cohort study of patients with a history of stroke admitted with stroke codes.
• Inclusion of patients diagnosed with SE mimicking stroke and a control group with stroke relapse.
• Utilized EEG, CT scans, and CT angiography/perfusion imaging for diagnosis.
• Compared clinical characteristics, seizure duration, antiepileptic drug use, mortality, and functional outcomes (m-RS, Engel scale).

Main Results:

• Eleven patients were diagnosed with SE mimicking stroke, compared to 65 with stroke relapse.
• Temporal lobe involvement was more common in the SE group (p=0.036).
• SE recurred in 36.4% of patients, with good seizure control achieved in 62.5% (Engel scale=1).
• Mortality at 12 months differed significantly between ischemic and hemorrhagic stroke types (p<0.005).

Conclusions:

• Status epilepticus is a significant consideration in patients with prior stroke presenting with acute neurological symptoms.
• Electroencephalogram (EEG) is an essential diagnostic tool in the acute stroke setting for patients with a history of stroke.
• Prompt diagnosis and management of SE can prevent misdiagnosis as stroke recurrence and improve patient outcomes.