Role of associated cortical lesions in motor partial seizures and lenticulostriate infarcts.

In a population-based study, we evaluated seizures occurring in the first 15 days after strokes among 1,640 consecutive patients who had ischemic (814 infarcts with atheroma and 126 with cardiogenic embolism, 273 lacunar infarcts, 259 transient ischemic attacks) or hemorrhagic stroke (129 supratentorial hematomas and 24 subarachnoïd hemorrhage) on computed tomography (CT) scan. Ninety patients had an epileptic seizure in the first 15 days after stroke onset. Thirteen of the 90 had a lenticulostriate infarct, diagnosed on CT scan, without an apparent ipsilateral cortical ischemic lesion. No lenticulostriate hematoma was observed with seizures. To determine the possible existence of an ipsilateral cortical lesion, magnetic resonance imaging (MRI) with gadolinium perfusion, and HMPAO single photon emission CT (SPECT) were performed in the 13 patients with seizures. MRI showed an associated ipsilateral posterofrontal or anterotemporal cortical ischemic lesion in 11 cases, and SPECT showed decreased blood flow in the ipsilateral frontal area in all cases (superficial sylvian territory). Overall, 56 patients had a lenticulostriate infarct and clinical, CT, and MRI data from the 13 with seizures was compared with those of the 43 without seizures. Two criteria differentiated the two groups: the size of the lenticulostriate infarct was larger (8.3 vs. 3.9 cm3) and ipsilateral cortical ischemic lesions were more frequent in the group with seizures (84 vs. 9%).