Abstracts

Rationale: Status epilepticus can be an initial manifestation of an acute stroke and may occur during its early clinical course. In the elderly patient population, stroke is the most common etiology for status epilepticus. The common neurobiology behind stroke and status epilepticus remains unclear. Acute ischemia releases excitatory amino acids, mainly glutamate, which produces a cascade of events. Down regulation in efficacy of GABA may be a mechanism behind status epilepticus in stroke. It is speculated that stroke induces molecular and cellular alterations in the neuronal circuits, leading to hyper-excitability that eventually generates spontaneous seizures. We present a case with remote posterior cerebral artery stroke, in which the patient presented initially with focal Jacksonian march followed by focal motor status epilepticus. Methods: We evaluated patients who presented with status epilepticus since 1998. Hospital medical charts were reviewed and database was obtained. Results: The patient was a 77-year-old woman with a medical history of hypertension, diabetes, atrial fibrillation, old right posterior cerebral infarct (PCA), and two previous status epliepticus. She initially presented with left facial focal seizures, which were migrating to her left arm and left leg. Drooling was followed by an alteration of awareness, and generalized convulsive status epilepticus. She was intubated and was started on propofol drip. She was admitted with two similar two prior status epilepticus and was maintained on phenytoin sodium. There was no prior smoking history. Her magnet resonance imaging (MRI) failed to reveal any acute stroke or vessel occlusion. She had similar previous MRI in past with old right PCA stroke. Her EEG monitoring showed continuous slowing and sharp waves over the right posterior quadrant. There weren’t any other metabolic or infectious abnormalities reported. After initial stabilization, she was treated with phenytoin and levitiracetam. Her focal left sided weakness was resolved within less than 24 hours, after optimum management. Conclusions: Late onset status epilepticus has been reported in literature after stroke, although it is not very common. Posterior cerebral stroke is more often associated with late onset status epilepticus. Based on our knowledge, recurrent status epilepticus from a remote stroke has not been reported in literature. More prospective clinical trials may be helpful to evaluate late onset status epilepticus in stroke.