Abstracts

RATIONALE: The reported proportion of stroke patients who experience early seizures varies from 3.9% to 43%. Stroke is a common risk factor for seizures in elderly. However there is little known about the epidemiology of seizure in the young adult population with stroke. Our objective was to study the occurrence of seizure in the young adult of age15 to 45 with acute stroke.
METHODS: Retrospective chart review was done in patients between ages 15-45 who were admitted to the University of Alberta Hospital from January 1, 1990 to December 31, 1999 with acute ischemic or hemorrhagic stroke and who experienced seizure either at the presentation or during their hospital stay. The results of risk factors, etiology, morbidity and mortality were entered into a database.
RESULTS: Acute stroke was diagnosed in 586 patients. Of those 383 (65%) were hemorrhagic and 203 (35%) non-hemorrhagic. Seizures occured in 98 (17%) patients, 71 (73%) at the presentation and 27 (27%) during hospitalization. Eighty-eight patients (90%) experienced generalized and 10 (10%) partial seizures. From 98 patients with seizures, 84 (85%) had hemorrhagic and 14 (15%) non-hemorrhagic strokes. From hemorrhagic stroke patients with seizure, 42 (50%) experienced subarachnoid hemorrhage, 24 (25%) lobar, 11 (11%) extradural hematoma and 7 (7%) deep brain, brain stem, or intraventicular hemorrhage. The most common causes of non-hemorrhagic stroke with seizures were venous sinus thrombosis, SLE, vasculitis and cardioembolic. Patients with seizure had significantly higher rate of complications including stroke recurrence (52% vs 24%), sepsis (20% vs 6%) and aspiration pneumonia (52% vs 24%). Twenty-eight patients with seizure (29%) died in hospital which constituted 27% of the total mortality.
CONCLUSIONS: Our experience with a large number of young adults with acute stroke shows that early seizure is a common occurence in this population. Seizures in stroke patients were more commonly generalized and occured more frequently at the presentation of hemorrhagic strokes. Young patients with stroke and seizure experienced significantly higher mortality and morbidity than their seizure free counterparts. Further follow up study is underway to see if early seizure in this young population is a predictor of developing epilepsy, and whether antiepileptic therapy is warranted.