Abstracts

Rationale: Stroke is the most frequent underlying etiology of acute symptomatic seizures in adults. The reported incidence of post-stroke seizures (PSS) varies widely and ranges from 2 to 20%.  Intracranial hemorrhage has been reported as a risk factor in PSS. However, there is little known data whether cerebral microhemorrhage (CM) is a risk factor for PSS. CM are commonly described as small focal cerebral hemorrhages often only seen on T2* sequences such as gradient echo imaging and susceptibility weighted imaging. We set out to ascertain whether CM is a risk factor for seizures at our institution in a well-defined inclusive stroke population. We also sought to determine if there are any associated risk factors for CM in this subpopulation. Methods: We randomly reviewed 521 patients from a database of 696 patients in the New York Presbyterian/Weill Cornell database of all patients who were evaluated to receive tissue plasminogen activator (tPA) for stroke (“stroke code” patients) in 2012-2013. Records were individually reviewed by a board certified epileptologist to identify patients who had PSS. The presence of CM was based on imaging report by our neuro-radiologist. Patients were excluded from the current analysis if they had a history of seizures prior to stroke, absence of acute stroke on neuroimaging, presence or history of intracranial hemorrhage, progressive neurologic disease that can cause seizure (e.g. multiple sclerosis) or missing records. Chi square analysis and student’s t-test was performed for statistical analysis.    Results: 521 patients from the database were reviewed. 179 met the exclusion criteria leaving a total of 342 patients in the dataset. The median age was 75 years old and 50% were female. 11 of 342 patients had PSS. Out of the 342 patients, 257 had post-hospitalization follow up, with a median follow up time of 867 days. 46 of the 342 patients had CM (23 with cortical involvement). In total, 11 patients had PSS. None of the patients with CM had PSS but this did not reach statistical significance (p = 0.18). Patients with CM were significantly more likely to have hypertension (p < 0.01). Aside from hypertension, there was no significant difference in age, gender, diabetes, cardiac disease, and dyslipidemia between those with CM and those without.  Conclusions: None of the patients considered for tPA at our hospital with evidence of radiographic CM had PSS.  However, our results did not reach statistical significance. Thus, our study found no correlation between CM and the development of PSS. We also found that patients with CM were significantly more likely to be hypertensive which is not surprising since hypertension is a risk factor for CM.  In the future, a larger dataset would be helpful to confirm our preliminary results that CM are significantly less likely to have PSS. Funding: No funding was received in support of this abstract