Acute Ischemic Stroke Presentation Masked by Falsely Localizing Motor Seizure: A Clinical Case Series

Area of Science:

• Neurology
• Neuroscience
• Stroke Research

Background:

• Acute ischemic stroke, particularly large vessel occlusion (LVO), is a major cause of disability.
• Seizures are a known complication of stroke, but focal seizures originating from chronic infarcts in LVO patients without prior seizure history are rarely reported.
• Understanding the mechanisms behind post-stroke seizures is crucial for improving patient outcomes.

Purpose of the Study:

• To describe a novel observation of focal seizure activity in patients with acute ischemic stroke and large vessel occlusion.
• To investigate the potential mechanisms underlying focal seizures localizing to chronic, contralateral infarcts in this patient population.

Main Methods:

• This study presents a case series of four patients.
• Patients had acute ischemic stroke secondary to large vessel occlusion.
• Patients presented with focal seizure activity localizable to a chronic, contralateral infarct and had no prior history of seizures.

Main Results:

• Four patients with acute ischemic stroke and LVO, without a history of seizures, exhibited focal seizure activity.
• The seizure activity was consistently localized to a chronic, contralateral infarct.
• This represents a novel clinical observation in stroke patients.

Conclusions:

• The observed phenomenon of focal seizures in chronic contralateral infarcts following acute ischemic stroke is not fully understood.
• Potential explanations include disrupted interhemispheric inhibitory connections.
• Epileptogenic changes within chronically infarcted brain tissue may also contribute to seizure generation.