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Early seizures after ischemic stroke: focus on thrombolysis

Published online by Cambridge University Press:  27 March 2019

Gergely Feher Open the ORCID record for Gergely Feher [Opens in a new window] ,
Zsuzsanna Gurdan ,
Katalin Gombos ,
Katalin Koltai ,
Gabriella Pusch ,
Antal Tibold  and
Laszlo Szapary
Gergely Feher*
Affiliation:
Centre for Occupational Medicine, Medical School, University of Pécs, Pécs, Hungary
Zsuzsanna Gurdan
Affiliation:
Department of Paediatric and Adolescent Dentistry, Medical School, University of Pécs, Pécs, Hungary
Katalin Gombos
Affiliation:
Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
Katalin Koltai
Affiliation:
First Department of Medicine, Medical School, University of Pecs, Pécs, Hungary
Gabriella Pusch
Affiliation:
Department of Neurology, Medical School, University of Pecs, Pécs, Hungary
Antal Tibold
Affiliation:
Centre for Occupational Medicine, Medical School, University of Pécs, Pécs, Hungary
Laszlo Szapary
Affiliation:
Department of Neurology, Medical School, University of Pecs, Pécs, Hungary
*
*Address correspondence to: Gergely Feher, Centre for Occupational Medicine, Medical School, University of Pécs, 7624 Pécs, Nyár u. 8, Hungary (Email: [email protected])
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Abstract

Introduction.

Stroke is a significant underlying cause of epilepsy. Seizures due to ischemic stroke (IS) are generally categorized into early seizures (ESs) and late seizures (LSs). Seizures in thrombolysis situations may raise the possibility of other etiology than IS.

Aim.

We overtook a systematic review focusing on the pathogenesis, prevalence, risk factors, detection, management, and clinical outcome of ESs in IS and in stroke/thrombolysis situations. We also collected articles focusing on the association of recombinant tissue-type plasminogen activator (rt-PA) treatment and epileptic seizures.

Results.

We have identified 37 studies with 36,775 participants. ES rate was 3.8% overall in patients with IS with geographical differences. Cortical involvement, severe stroke, hemorrhagic transformation, age (<65 years), large lesion, and atrial fibrillation were the most important risk factors. Sixty-one percent of ESs were partial and 39% were general. Status epilepticus (SE) occurred in 16.3%. 73.6% had an onset within 24 h and 40% may present at the onset of stroke syndrome. Based on EEG findings seizure-like activity could be detected only in approximately 18% of ES patients. MRI diffusion-weighted imaging and multimodal brain imaging may help in the differentiation of ischemia vs. seizure. There are no specific recommendations with regard to the treatment of ES.

Conclusion.

ESs are rare complications of acute stroke with substantial burden. A significant proportion can be presented at the onset of stroke requiring an extensive diagnostic workup.

Keywords

Emergency serviceimagingischemic strokeseizurestrokethrombolysistreatment
Type
Review
Information
CNS Spectrums , Volume 25 , Issue 1 , February 2020 , pp. 101 - 113
Copyright
© Cambridge University Press 2019

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Footnotes

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

All authors equally contributed to the manuscript including study concept and design, collection of data, analysis and interpretation of data, writing of manuscript, and critical revision of manuscript.

References

REFERENCES:

Hauser, WA, Annegers, JF, Kurland, LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia. 1993; 34: 453–468.Google Scholar
Kim, B, Sila, C. Seizures in ischemic stroke. In: Koubeissi, M, Alshekhlee, A, Mehndiratta, P, eds. Seizures in Cerebrovascular Disorders. New York, NY: Springer; 2015.Google Scholar
Camilo, O, Goldstein, LB. Seizures and epilepsy after ischemic stroke. Stroke. 2004; 35(7): 1769–1775.Google Scholar
Commission on Epidemiology and Prognosis International League Against Epilepsy. Guidelines for epidemiologic studies on epilepsy. Epilepsia. 1993; 34: 592–596.Google Scholar
Knecht, T, Story, J, Liu, J, et al.Adjunctive therapy approaches for ischemic stroke: innovations to expand time window of treatment. Int J Mol Sci. 2017; 18(12).Google Scholar
Hacke, W, Kaste, M, Fieschi, C, et al.Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European--Australasian Acute Stroke Study Investigators. Lancet. 1998; 352: 1245–1251.Google Scholar
Winkler, DT, Fluri, F, Fuhr, P, et al.Thrombolysis in stroke mimics: frequency, clinical characteristics, and outcome. Stroke. 2009; 40: 1522–1525.Google Scholar
Scott, PA, Silbergleit, R. Misdiagnosis of stroke in tissue plasminogen activator-treated patients: characteristics and outcomes. Ann Emerg Med. 2003; 42: 611–618.Google Scholar
Jauch, EC, Saver, JL, Adams, HP Jr, et al.Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013; 44(3): 870–947.Google Scholar
Tan, ML, Ng, A, Pandher, PS, et al.Tissue plasminogen activator does not alter development of acquired epilepsy. Epilepsia. 2012; 53(11): 1998–2004.Google Scholar
Alvarez, V, Rossetti, AO, Papavasileiou, V, et al.Acute seizures in acute ischemic stroke: Does thrombolysis have a role to play? J Neurol. 2013; 260(1): 55–61.Google Scholar
Balogun, IO, Brown, A, Bertoni, M, et al.A stroke registry data on the use of intravenous recombinant tissue plasminogen activator in stroke of unknown time of onset. J Stroke Cerebrovasc Dis. 2016; 25(8): 1843–1850.Google Scholar
Vilela, P. Acute stroke differential diagnosis: stroke mimics. Eur J Radiol. 2017; 96: 133–144.Google Scholar
Hedna, VS, Shukla, PP, Waters, MF. Seizure mimicking stroke: role of CT perfusion. J Clin Imaging Sci. 2012; 2: 32.Google Scholar
Reddy, DS, Bhimani, A, Kuruba, R, et al.Prospects of modeling poststroke epileptogenesis. J Neurosci Res. 2017; 95(4): 1000–1016.Google Scholar
Ferlazzo, E, Gasparini, S, Beghi, E, et al.Epilepsy in cerebrovascular diseases: review of experimental and clinical data with meta-analysis of risk factors. Epilepsia. 2016; 57(8): 1205–1214.Google Scholar
Tanaka, T, Ihara, M. Post-stroke epilepsy. Neurochem Int. 2017; 107: 219–228.Google Scholar
Xie, WJ, Dong, M, Liu, Q, et al.Early predictors and prevention for post-stroke epilepsy: changes in neurotransmitter levels. Transl Neurosci. 2016; 7(1): 1–5.Google Scholar
Kim, HJ, Park, KD, Choi, KG, et al.Clinical predictors of seizure recurrence after the first post-ischemic stroke seizure. BMC Neurol. 2016; 16(1): 212.Google Scholar
Bryndziar, T, Sedova, P, Kramer, NM, et al.Seizures following ischemic stroke: frequency of occurrence and impact on outcome in a long-term population-based study. J Stroke Cerebrovasc Dis. 2016; 25(1): 150–156.Google Scholar
Mohamed, C, Kissani, N. Early seizures in acute stroke. Pan Afr Med J. 2015; 20: 136.Google Scholar
Wang, G, Jia, H, Chen, C, et al.Analysis of risk factors for first seizure after stroke in Chinese patients. Biomed Res Int. 2013; 2013: 702871.Google Scholar
Arntz, R, Rutten-Jacobs, L, Maaijwee, N, et al.Post-stroke epilepsy in young adults: a long-term follow-up study. PLoS One. 2013; 8(2): e55498.Google Scholar
Jung, S, Schindler, K, Findling, O, et al.Adverse effect of early epileptic seizures in patients receiving endovascular therapy for acute stroke. Stroke. 2012; 43(6): 1584–1590.Google Scholar
Alberti, A, Paciaroni, M, Caso, V, et al.Early seizures in patients with acute stroke: frequency, predictive factors, and effect on clinical outcome. Vasc Health Risk Manag. 2008; 4(3): 715–720.Google Scholar
Khealani, BA, Ali, S, Baig, SM. Post stroke seizures: descriptive study from a tertiary care centre in Pakistan. J Pak Med Assoc. 2008; 58(7): 365–368.Google Scholar
Cordonnier, C, Hénon, H, Derambure, P, et al.Early epileptic seizures after stroke are associated with increased risk of new-onset dementia. J Neurol Neurosurg Psychiatry. 2007; 78(5): 514–516.Google Scholar
Chen, Z, Churilov, L, Koome, M, et al.Post-stroke seizures is associated with low Alberta stroke program early CT score. Cerebrovasc Dis. 2017; 43(5–6): 259–265.Google Scholar
Hundozi, Z, Shala, A, Boshnjaku, D, et al.Hypertension on admission is associated with a lower risk of early seizures after stroke. Seizure. 2016; 36: 40–43.Google Scholar
Conrad, J, Pawlowski, M, Dogan, M, et al.Seizures after cerebrovascular events: risk factors and clinical features. Seizure. 2013; 22(4): 275–282.Google Scholar
Hamidou, B, Aboa-Eboulé, C, Durier, J, et al.Prognostic value of early epileptic seizures on mortality and functional disability in acute stroke: The Dijon Stroke Registry (1985–2010). J Neurol. 2013; 260(4): 1043–1051.Google Scholar
Couillard, P, Almekhlafi, MA, Irvine, A, et al.Subacute seizure incidence in thrombolysis-treated ischemic stroke patients. Neurocrit Care. 2012; 16(2): 241–245.Google Scholar
Strzelczyk, A, Haag, A, Raupach, H, et al.Prospective evaluation of a post-stroke epilepsy risk scale. J Neurol. 2010; 257(8): 1322–1326.Google Scholar
De Reuck, J, Van Maele, G. Acute ischemic stroke treatment and the occurrence of seizures. Clin Neurol Neurosurg. 2010; 112(4): 328–331.Google Scholar
Stefanidou, M, Das, RR, Beiser, AS, et al.Incidence of seizures following initial ischemic stroke in a community-based cohort: the Framingham Heart Study. Seizure. 2017; 47: 105–110.Google Scholar
Cheung, CM, Tsoi, TH, Au-Yeung, M, et al.Epileptic seizure after stroke in Chinese patients. J Neurol. 2003; 250(7): 839–843.Google Scholar
Kammersgaard, LP, Olsen, TS. Poststroke epilepsy in the Copenhagen stroke study: incidence and predictors. J Stroke Cerebrovasc Dis. 2005; 14(5): 210–214.Google Scholar
Labovitz, DL, Hauser, WA, Sacco, RL. Prevalence and predictors of early seizure and status epilepticus after first stroke. Neurology. 2001; 57(2): 200–206.Google Scholar
Lamy, C, Domigo, V, Semah, F, et al.Early and late seizures after cryptogenic ischemic stroke in young adults. Neurology. 2003; 60(3): 400–404.Google Scholar
Cordonnier, C, Hénon, H, Derambure, P, et al.Influence of pre-existing dementia on the risk of post-stroke epileptic seizures. J Neurol Neurosurg Psychiatry. 2005; 76(12): 1649–1653.Google Scholar
Bladin, CF, Alexandrov, AV, Bellavance, A, et al.Seizures after stroke: a prospective multicenter study. Arch Neurol. 2000; 57(11): 1617–1622.Google Scholar
Serafini, A, Gigli, GL, Gregoraci, G, et al.Are early seizures predictive of epilepsy after a Stroke? Results of a population-based study. Neuroepidemiology. 2015; 45(1): 50–58.Google Scholar
Dewan, KR, Rana, PV. A study of seven day mortality in acute ischemic stroke in a teaching hospital in Chitwan. J Nepal Health Res Counc. 2014; 12(26): 33–38.Google Scholar
Panitchote, A, Tiamkao, S. Prevalence of post-stroke seizures in Srinagarind Hospital. J Med Assoc Thai. 2010; 93(9): 1037–1042.Google Scholar
Goswami, RP, Karmakar, PS, Ghosh, A. Early seizures in first-ever acute stroke patients in India: incidence, predictive factors and impact on early outcome. Eur J Neurol. 2012; 19(10): 1361–1366.Google Scholar
Aiwansoba, IF, Chukwuyem, OW. Early post-acute stroke seizures: clinical profile and outcome in a Nigerian stroke unit. Ann Afr Med. 2014; 13(1): 11–15.Google Scholar
Pezzini, A, Grassi, M, Del Zotto, E, et al.Complications of acute stroke and the occurrence of early seizures. Cerebrovasc Dis. 2013; 35(5): 444–450.Google Scholar
Procaccianti, G, Zaniboni, A, Rondelli, F, et al.Seizures in acute stroke: incidence, risk factors and prognosis. Neuroepidemiology. 2012; 39(1): 45–50.Google Scholar
Mecarelli, O, Pro, S, Randi, F, et al.EEG patterns and epileptic seizures in acute phase stroke. Cerebrovasc Dis. 2011; 31(2): 191–198.Google Scholar
Beghi, E, D’Alessandro, R, Beretta, S, et al.Incidence and predictors of acute symptomatic seizures after stroke. Neurology. 2011; 77(20): 1785–1793.Google Scholar
Misirli, H, Ozge, A, Somay, G, et al.Seizure development after stroke. Int J Clin Pract. 2006; 60(12): 1536–1541.Google Scholar
Dhanuka, AK, Misra, UK, Kalita, J. Seizures after stroke: a prospective clinical study. Neurol India. 2001; 49(1): 33–36.Google Scholar
OPHELIE investigators and the STROKAVENIR network. Proportion of single-chain recombinant tissue plasminogen activator and outcome after stroke. Neurology. 2016; 87(23): 2416–2426.Google Scholar
De Reuck, JL, Van Maele, G. Seizures and epilepsy in patients with a posterior circulation infarct. J Stroke Cerebrovasc Dis. 2012; 21(1): 1–4.Google Scholar
Gupta, SR, Naheedy, MH, Elias, D, et al.Postinfarction seizures. A clinical study. Stroke. 1988; 19(12): 1477–1481.Google Scholar
Horner, S, Ni, XS, Duft, M, et al.EEG, CT and neurosonographic findings in patients with postischemic seizures. J Neurol Sci. 1995; 132(1): 57–60.Google Scholar
De Reuck, J, De Groote, L, Van Maele, G. Single seizure and epilepsy in patients with a cerebral territorial infarct. J Neurol Sci. 2008; 271(1–2): 127–130.Google Scholar
Velioğlu, SK, Ozmenoğlu, M, Boz, C, et al.Status epilepticus after stroke. Stroke. 2001; 32(5): 1169–1172.Google Scholar
Austein, F, Huhndorf, M, Meyne, J, et al.Advanced CT for diagnosis of seizure-related stroke mimics. Eur Radiol. 2018; 28(5):1791–1800.Google Scholar
Sylaja, PN, Dzialowski, I, Krol, A, et al.Role of CT angiography in thrombolysis decision-making for patients with presumed seizure at stroke onset. Stroke. 2006; 37(3): 915–917.Google Scholar
Hufnagel, A, Weber, J, Marks, S, et al.Brain diffusion after single seizures. Epilepsia. 2003; 44(1): 54–63.Google Scholar
Konermann, S, Marks, S, Ludwig, T, et al.Presurgical evaluation of epilepsy by brain diffusion: MR-detected effects of flumazenil on the epileptogenic focus. Epilepsia. 2003; 44(3): 399–407.Google Scholar
Senn, P, Lövblad, KO, Zutter, D, et al.Changes on diffusion-weighted MRI with focal motor status epilepticus: case report. Neuroradiology. 2003; 45(4): 246–249.Google Scholar
Szabo, K, Poepel, A, Pohlmann-Eden, B, et al.Diffusion-weighted and perfusion MRI demonstrates parenchymal changes in complex partial status epilepticus. Brain. 2005; 128(Pt 6): 1369–1376.Google Scholar
Hong, KS, Cho, YJ, Lee, SK, et al.Diffusion changes suggesting predominant vasogenic oedema during partial status epilepticus. Seizure. 2004; 13(5): 317–321.Google Scholar
Parmar, H, Lim, SH, Tan, NC, et al.Acute symptomatic seizures and hippocampus damage: DWI and MRS findings. Neurology. 2006; 66(11): 1732–1735.Google Scholar
Milligan, TA, Zamani, A, Bromfield, E. Frequency and patterns of MRI abnormalities due to status epilepticus. Seizure. 2009; 18(2): 104–108.Google Scholar
Toledo, M, Munuera, J, Sueiras, M, et al.MRI findings in aphasic status epilepticus. Epilepsia. August 2008; 49(8): 1465–1469.Google Scholar
Lee, KY, Chen, CJ, Peng, YY, et al.Reversible signal changes in MR diffusion-weighted imaging in a patient with status epilepticus. Acta Neurol Taiwan. 2011; 20(1): 42–46.Google Scholar
Di Bonaventura, C, Bonini, F, Fattouch, J, et al.Diffusion-weighted magnetic resonance imaging in patients with partial status epilepticus. Epilepsia. 2009; 50(Suppl 1): 45–52.Google Scholar
Kumral, E, Uncu, G, Dönmez, I, et al.Impact of poststroke seizures on neurological deficits: magnetic resonance diffusion-weighted imaging study. Eur Neurol. 2013; 69(4): 200–206.Google Scholar
Maalouf, N, Keyrouz, SG. Early appearance of diffusion-weighted hyperintensities in aphasic status epilepticus. A case report. Neuroradiol J. 2012; 25(1): 36–39.Google Scholar
Chatzikonstantinou, A, Gass, A, Förster, A, et al.Features of acute DWI abnormalities related to status epilepticus. Epilepsy Res. 2011; 97(1–2): 45–51.Google Scholar
Koo, DL, Jeong, HG, Nam, H. Thalamic hyperintensity on diffusion-weighted MRI in a patient with nonconvulsive status epilepticus. J Epilepsy Res. June 30,2013; 3(1): 32–34.Google Scholar
Cartagena, AM, Young, GB, Lee, DH, et al.Reversible and irreversible cranial MRI findings associated with status epilepticus. Epilepsy Behav. 2014; 33: 24–30.Google Scholar
Ohe, Y, Hayashi, T, Deguchi, I, et al.MRI abnormality of the pulvinar in patients with status epilepticus. J Neuroradiol. 2014; 41(4): 220–226.Google Scholar
Cianfoni, A, Caulo, M, Cerase, A, et al.Seizure-induced brain lesions: a wide spectrum of variably reversible MRI abnormalities. Eur J Radiol. 2013; 82(11): 1964–1972.Google Scholar
Rennebaum, F, Kassubek, J, Pinkhardt, E, et al.Status epilepticus: clinical characteristics and EEG patterns associated with and without MRI diffusion restriction in 69 patients. Epilepsy Res. 2016; 120: 55–64.Google Scholar
Williams, J, Mullins, G, Delanty, N, et al.The spectrum of peri-ictal MRI changes; four illustrative cases. Seizure. 2017; 50: 189–193.Google Scholar
Jabeen, SA, Cherukuri, P, Mridula, R, et al.A prospective study of diffusion weighted magnetic resonance imaging abnormalities in patients with cluster of seizures and status epilepticus. Clin Neurol Neurosurg. 2017; 155: 70–74.Google Scholar
Wiest, R, von Bredow, F, Schindler, K, et al.Detection of regional blood perfusion changes in epileptic seizures with dynamic brain perfusion CT -- a pilot study. Epilepsy Res. 2006; 72(2–3): 102–110.Google Scholar
Gelfand, JM, Wintermark, M, Josephson, SA. Cerebral perfusion-CT patterns following seizure. Eur J Neurol. 2010; 17(4): 594–601.Google Scholar
Hauf, M, Slotboom, J, Nirkko, A, et al.Cortical regional hyperperfusion in nonconvulsive status epilepticus measured by dynamic brain perfusion CT. AJNR Am J Neuroradiol. 2009; 30(4): 693–698.Google Scholar
Masterson, K, Vargas, MI, Delavelle, J. Postictal deficit mimicking stroke: role of perfusion CT. J Neuroradiol. 2009; 36(1): 48–51.Google Scholar
Mathews, MS, Smith, WS, Wintermark, M, et al.Local cortical hypoperfusion imaged with CT perfusion during postictal Todd’s paresis. Neuroradiology. 2008; 50(5): 397–401.Google Scholar
Royter, V, Paletz, L, Waters, MF. Stroke vs. status epilepticus. A case report utilizing CT perfusion. J Neurol Sci. 2008; 266(1–2): 174–176.Google Scholar
Shelly, S, Maggio, N, Boxer, M, et al.Computed tomography perfusion maps reveal blood flow dynamics in postictal patients: a novel diagnostic tool. Isr Med Assoc J. 2017; 19(9): 553–556.Google Scholar
Kubiak-Balcerewicz, K, Fiszer, U, Nagańska, E, et al.Differentiating stroke and seizure in acute setting-perfusion computed tomography? J Stroke Cerebrovasc Dis. 2017; 26(6): 1321–1327.Google Scholar
López Ruiz, R, Quintas, S, Largo, P, et al.Usefulness of multiparametric computerized tomography findings in the differential diagnosis of stroke mimics of epileptic origin: a preliminary study. Neurologia. 2019; 34(2):73–79.Google Scholar
Payabvash, S, Oswood, MC, Truwit, CL, et al.Acute CT perfusion changes in seizure patients presenting to the emergency department with stroke-like symptoms: correlation with clinical and electroencephalography findings. Clin Radiol. 2015; 70(10): 1136–1143.Google Scholar
Calistri, V, Caramia, F, Bianco, F, et al.Visualization of evolving status epilepticus with diffusion and perfusion MR imaging. AJNR Am J Neuroradiol. 2003; 24(4): 671–673.Google Scholar
Flacke, S, Wüllner, U, Keller, E, et al.Reversible changes in echo planar perfusion- and diffusion-weighted MRI in status epilepticus. Neuroradiology. 2000; 42(2): 92–95.Google Scholar
Warach, S, Levin, JM, Schomer, DL,, et al.Hyperperfusion of ictal seizure focus demonstrated by MR perfusion imaging. AJNR Am J Neuroradiol. 1994; 15(5): 965–968.Google Scholar
Gaxiola-Valdez, I, Singh, S, Perera, T, et al.Seizure onset zone localization using postictal hypoperfusion detected by arterial spin labelling MRI. Brain. 2017; 140(11): 2895–2911.Google Scholar
Chen, G, Lei, D, Ren, J, et al.Patterns of postictal cerebral perfusion in idiopathic generalized epilepsy: a multi-delay multi-parametric arterial spin labelling perfusion MRI study. Sci Rep. 2016; 6: 28867.Google Scholar
Wang, JZ, Vyas, MV, Saposnik, G, et al.Incidence and management of seizures after ischemic stroke: systematic review and meta-analysis. Neurology. 2017; 89(12): 1220–1228.Google Scholar
Zou, S, Wu, X, Zhu, B, et al.The pooled incidence of post-stroke seizure in 102 008 patients. Top Stroke Rehabil. 2015; 22(6): 460–467.Google Scholar
Karunaratne, K, Bertoni, M, Balogun, I, et al.The right diagnosis but the wrong pathway? Listeria meningitis mimicking stroke. Pract Neurol. 2016; 16(3): 220–222.Google Scholar
Onder, H, Arsava, EM, Topcuoglu, MA, et al.Do video-EEG monitoring findings in ICU patients with acute stroke predict development of seizures and survival during follow-up? Clin EEG Neurosci. 2017; 48(6): 417–421.Google Scholar
Finnigan, S, van Putten, MJ. EEG in ischaemic stroke: quantitative EEG can uniquely inform (sub-)acute prognoses and clinical management. Clin Neurophysiol. 2013; 124(1): 10–19.Google Scholar
Coutts, SB, Lev, MH, Eliasziw, M, et al.ASPECTS on CTA source images versus unenhanced CT: added value in predicting final infarct extent and clinical outcome. Stroke. 2004; 35: 2472–2476.Google Scholar
Schramm, P, Schellinger, PD, Fiebach, FB, et al.Comparison of CT and CT angiography source images with diffusion-weighted imaging in patients with acute stroke within 6 hours after onset. Stroke. 2002; 33: 2426–2432.Google Scholar
González, RG, Schaefer, PW, Buonanno, FS, et al.Diffusion-weighted MR imaging: diagnostic accuracy in patients imaged within 6 hours of stroke symptom onset. Radiology. 1999; 210: 155–162.Google Scholar
Eichel, R, Hur, TB, Gomori, JM, et al.Use of DWI-only MR protocol for screening stroke mimics. J Neurol Sci. 2013; 328(1–2): 37–40.Google Scholar
Dawson, A, Cloud, GC, Pereira, AC, et al.Stroke mimic diagnoses presenting to a hyperacute stroke unit. Clin Med (Lond). 2016; 16(5): 423–426.Google Scholar
Quenardelle, V, Lauer-Ober, V, Zinchenko, I, et al.Stroke mimics in a stroke care pathway based on MRI screening. Cerebrovasc Dis. 2016; 42(3–4): 205–212.Google Scholar
Förster, A, Griebe, M, Gass, A, et al.Diffusion-weighted imaging for the differential diagnosis of disorders affecting the hippocampus. Cerebrovasc Dis. 2012; 33(2): 104–115.Google Scholar
Edlow, BL, Hurwitz, S, Edlow, JA. Diagnosis of DWI-negative acute ischemic stroke: a meta-analysis. Neurology. 2017; 89(3): 256–262.Google Scholar
CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project (CRISP) Investigators. Computed tomographic perfusion to predict response to recanalization in ischemic stroke. Ann Neurol. 2017; 81(6): 849–856.Google Scholar
Saba, L, Anzidei, M, Piga, M, et al.Multi-modal CT scanning in the evaluation of cerebrovascular disease patients. Cardiovasc Diagn Ther. 2014; 4(3): 245–262.Google Scholar
Mair, G, Wardlaw, JM. Imaging of acute stroke prior to treatment: current practice and evolving techniques. Br J Radiol. 2014; 87(1040): 20140216.Google Scholar
Rodan, LH, Aviv, RI, Sahlas, DJ, et al.Seizures during stroke thrombolysis heralding dramatic neurologic recovery. Neurology. 2006; 67(11): 2048–2049.Google Scholar
Lekoubou, A, Awoumou, JJ, Kengne, AP. Incidence of seizure in stroke patients treated with recombinant tissue plasminogen activator: a systematic review and meta-analysis. Int J Stroke. 2017; 12(9): 923–931.Google Scholar
Docagne, F, Parcq, J, Lijnen, R, et al.Understanding the functions of endogenous and exogenous tissue-type plasminogen activator during stroke. Stroke. 2015; 46: 314–320.Google Scholar
Xu, T, Ou, S, Liu, X, et al.Association between seizures after ischemic stroke and stroke outcome: a systematic review and meta-analysis. Medicine (Baltimore). 2016; 95(27): e4117.Google Scholar
Lv, RJ, Wang, Q, Cui, T, et al.Status epilepticus-related etiology, incidence and mortality: a meta-analysis. Epilepsy Res. 2017; 136: 12–17.Google Scholar
European Stroke Organisation (ESO). Guidelines for the management of post-stroke seizures and epilepsy. Eur Stroke J. 2017; 2(2): 103–115.Google Scholar
2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018; 49(3):e46–e110.Google Scholar