Louisiana State University Health Sciences Center, New Orleans, LA, USA.
J Investig Med High Impact Case Rep. 2020 Jan-Dec;8:2324709620940497. doi: 10.1177/2324709620940497.
Risk factors for early-onset seizures in acute ischemic stroke include anterior circulation stroke, infarction of the cerebral cortex, large infarct size, and ischemic-to-hemorrhagic transformation. We define stroke-onset seizures as seizures occurring within 2 hours of stroke onset. A 64-year-old woman presented with top of the basilar artery syndrome-thalamic infarction occurred first and midbrain infarction 12 days later. She manifested stroke-onset seizures during midbrain infarction, which was heralded by stupor. Within 2 hours of the onset of stupor, she had a clonic seizure of the lower extremities, electroencephalography (EEG) revealed nonconvulsive status epilepticus, and an episode of convulsive movements of all extremities was recorded on video and on EEG. Continuous EEG recording showed epileptiform discharges that would appear, disappear, and reappear over a 3-week period. It took 3 weeks and 4 antiepileptic drugs to fully suppress cortical hyperexcitability, perhaps because injury to some midbrain structures resulted in global lowering of the seizure threshold. The most important risk factor for stroke-onset seizures appears to be posterior circulation stroke, particularly brainstem infarction. The difference in risk profile between stroke-onset seizures and other forms of early-onset seizures suggest that their pathophysiology is not exactly the same. Focusing some of the research spotlight on stroke-onset seizures can help us better understand their unique clinical, electrographic, radiologic, and pathophysiologic features.
急性缺血性脑卒中早期发作性癫痫的危险因素包括前循环卒中、大脑皮层梗死、大梗死灶和缺血性转化出血。我们将卒中发作性癫痫定义为卒中发作后 2 小时内发生的癫痫。一名 64 岁女性因基底动脉尖综合征-丘脑梗死首先发生，12 天后中脑梗死而就诊。她在中脑梗死时出现卒中发作性癫痫，以昏迷为前驱症状。在昏迷发作后 2 小时内，她出现下肢阵挛性癫痫发作，脑电图（EEG）显示非惊厥性癫痫持续状态，并在视频和 EEG 上记录到四肢全面抽搐发作。连续 EEG 记录显示癫痫样放电，在 3 周内出现、消失并再次出现。经过 3 周和 4 种抗癫痫药物治疗，皮质过度兴奋才完全得到抑制，这可能是由于某些中脑结构损伤导致全身性癫痫发作阈值降低。卒中发作性癫痫最重要的危险因素似乎是后循环卒中，特别是脑干梗死。卒中发作性癫痫和其他形式的早期发作性癫痫的风险特征差异表明，它们的病理生理学并不完全相同。将一些研究重点放在卒中发作性癫痫上，可以帮助我们更好地了解它们独特的临床、电生理、影像学和病理生理学特征。
