Background and purpose: Occasionally, seizures can be an early complication of ischemic stroke. Recent studies have shown that hemorrhagic transformation is a predictive factor for early seizures as a complication of AIS (acute ischemic stroke). Our research looked as early seizures as a complication of AIS (either seizures on presentation in the emergency department or seizures while admitted for acute stroke), correlation with hemorrhagic transformation (HT), and the implication with poor functional discharge outcomes.
Methods: We evaluated consecutive AIS patients from March 2014-April 2015 admitted to our comprehensive stroke center. The primary endpoint was the modified rankin scale (mRS) on discharge (“poor outcome” defined as a score of 3-6), and association with hemorrhagic transformation (defined as hemorrhagic transformation seen on repeat imaging - either CT or MRI). Seizures were defined as clinical seizures - we did not require EEG data for diagnosis of seizure.
Results: A total of 773 patients met inclusion criteria with a mean age 64, 49.3% female, and 36.6% black. Of these patients, 29 (3.7%) presented with seizures at onset or as an early complication of stroke while in the hospital. In our population, 15.5% of all AIS patients had HT, and 47.5% of all AIS patients had poor functional outcomes. In our patient population, seizures were not an independent risk factor for HT as a complication of AIS (after adjusting for SBP on presentation, age and NIHSS, OR 0.64, 95% CI: 0.18-2.28, P 0.493). We found that early seizures as a complication of AIS was an independent risk factor for poor functional outcome on discharge (after adjusting for SBP on presentation, age and NIHSS, OR 13.3, 95% CI 2.69-65.9, P 0.0015).
Conclusion: In our patient population, we did not find that seizure was an independent risk factor for HT as a complication for AIS. We did find that early seizures as a complication of AIS was an independent risk factor for poor functional outcome.