Watershed infarctions are more prone than other cortical infarcts to cause early-onset seizures

Arch Neurol. 2010 Oct;67(10):1219-23. doi: 10.1001/archneurol.2010.263.

Abstract

Background: Early-onset seizures(ESs) have been reported in 2% to 6% of strokes. Most previous studies have been retrospective and did not systematically perform cerebral magnetic resonance imaging (MRI).

Objective: To determine the prevalence and determinants of ESs in a prospective cohort.

Design: Prospective cohort study.

Setting: Stroke unit in an academic hospital.

Patients: Six hundred sixty-one consecutive individuals admitted to our stroke unit during an 18-month period for suspected stroke.

Main outcome measures: Initial investigations systematically included cerebral MRI. Among patients with MRI-confirmed cerebral infarction, individuals with ES, defined as occurring within 14 days of stroke, were identified.

Results: Three hundred twenty-eight patients had MRI-confirmed cerebral infarcts and 178 had cortical involvement. The ESs, all initially partial seizures, occurred in 14 patients (4.3%) and at stroke onset in 5 patients. The ESs occurred exclusively in patients with cortical involvement (P <.001). With infarcts involving the cerebral cortex, there was a higher risk of ESs in watershed infarctions than in territorial strokes (6 of 26 [23.1%] vs 8 of 152 [5.3%], P = .007). Logistic regression analysis showed an almost 4-fold increased risk of ES in patients with watershed infarctions compared with other cortical infarcts (odds ratio, 4.7; 95% confidence interval, 1.5- 15.4; P = .01). Age, sex, diabetes mellitus, hypertension, smoking, National Institutes of Health Stroke Scale score, and cardioembolic origin were not significant risk factors for ES.

Conclusions: The cortical hemispheric location of ischemic strokes is associated with a higher risk of ES. Among these patients, the watershed mechanism is a strong and independent determinant of stroke-related ES.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cerebral Infarction / complications*
  • Cohort Studies
  • Female
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Seizures / etiology*
  • Stroke / complications*
  • Stroke / pathology*
  • Young Adult