Stroke, orthostatic hypotension, and focal seizures

A 75-year-old man had development of left hemiparesis after a cerebral infarction. Nine months later, he was admitted to the hospital after generalized tonic clonic convulsion. In the hospital, he had clonic movement on the left side of the body. Even after acceptable control of orthostatic hypotension, rising from supine to standing position evoked slow waves over the right hemisphere on the EEG tracing. This example of focal seizures with orthostatic hypotension shows that previously compromised cerebral tissue or vessels may be vulnerable to changes in blood pressure. We suggest that convulsive movements associated with hypotension or syncope result from cortical mechanisms rather than brainstem tonic release mechanisms.