TY - JOUR
T1 - Seizure at stroke onset
T2 - Should it be an absolute contraindication to thrombolysis?
AU - Selim, Magdy
AU - Kumar, Sandeep
AU - Fink, John
AU - Schlaug, Gottfried
AU - Caplan, Louis R.
AU - Linfante, Italo
PY - 2002
Y1 - 2002
N2 - Background: Current guidelines for the treatment of acute ischemic stroke exclude patients with seizure at stroke onset from consideration for thrombolytic therapy. It may be difficult to differentiate an ischemic stroke from postictal Todd's paralysis by clinical examination and noncontrast CT scan. Magnetic resonance imaging (MRI) with diffusion- (DWI) and perfusion-weighted images (PWI) and angiography (MRA) can be used to confirm the diagnosis of an acute ischemic process in the presence of concurrent seizures. Methods: A case report of a patient who presented with seizures, in whom the combination of DWI/PWI MRI and MRA confirmed the diagnosis of an embolic ischemic stroke. The patient was treated with intravenous recombinant tissue plasminogen activator with clinical and radiological improvement. Conclusions: Treatment decisions with regard to thrombolysis in acute stroke patients should be based on parameters of cerebral perfusion, assessment of collateral blood flow and presence of potentially salvageable tissue. Modern neuroimaging techniques that can rapidly assess these variables, such as DWI/PWI MRI and MRA, can improve the current selection of patients who are likely to benefit from thrombolysis and extend its benefit to patients who would otherwise be excluded, such as those with seizures at stroke onset.
AB - Background: Current guidelines for the treatment of acute ischemic stroke exclude patients with seizure at stroke onset from consideration for thrombolytic therapy. It may be difficult to differentiate an ischemic stroke from postictal Todd's paralysis by clinical examination and noncontrast CT scan. Magnetic resonance imaging (MRI) with diffusion- (DWI) and perfusion-weighted images (PWI) and angiography (MRA) can be used to confirm the diagnosis of an acute ischemic process in the presence of concurrent seizures. Methods: A case report of a patient who presented with seizures, in whom the combination of DWI/PWI MRI and MRA confirmed the diagnosis of an embolic ischemic stroke. The patient was treated with intravenous recombinant tissue plasminogen activator with clinical and radiological improvement. Conclusions: Treatment decisions with regard to thrombolysis in acute stroke patients should be based on parameters of cerebral perfusion, assessment of collateral blood flow and presence of potentially salvageable tissue. Modern neuroimaging techniques that can rapidly assess these variables, such as DWI/PWI MRI and MRA, can improve the current selection of patients who are likely to benefit from thrombolysis and extend its benefit to patients who would otherwise be excluded, such as those with seizures at stroke onset.
KW - Diffusion-weighted images
KW - Magnetic resonance imaging
KW - Perfusion-weighted images
KW - Seizures
KW - Stroke
KW - Tissue plasminogen activator
UR - http://www.scopus.com/inward/record.url?scp=0036311460&partnerID=8YFLogxK
U2 - 10.1159/000063724
DO - 10.1159/000063724
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C2 - 12097852
AN - SCOPUS:0036311460
SN - 1015-9770
VL - 14
SP - 54
EP - 57
JO - Cerebrovascular Diseases
JF - Cerebrovascular Diseases
IS - 1
ER -