Epileptic seizures following ischaemic cerebral infarction

Clinical Picture, CT Findings and Prognosis
  • Claus R. Hornig
  • Thomas Büttner
  • Andreas Hufnagel
  • Karl Schröder-Rosenstock
  • Wolfgang Dorndorf
Original Articles


Clinical, CT and EEG findings of 100 consecutive patients suffering from epileptic seizures following hemispheric cerebral infarction were evaluated retrospectively. All patients were followed up for an average of 49 months. Twelve patients suffered from cardiogenic brain embolism, 20 had an occlusive disease of the internal cerebral artery. Forty-seven patients had a single middle cerebral artery infarct, 6 each a posterior cerebral artery or watershed infarct. CT showed lacunes in only 6 cases, 8 had multiple larger infarcts and 27 were normal. Seventy-six patients suffered from generalized seizures, 54 from partial fits, predominantly focal motor seizures. Seventy-one patients had their first seizure within the 1st year after stroke, 30 within 2 weeks after the infarct. The interval between stroke and the first epileptic fit exceeded 1 year in the remaining 29 cases. If the first fit occurred in the acute phase after stroke, the risk of further ones was significantly lower than when the first fit occurred in the chronic stage. The frequency of fits mainly depended on the occurrence of epileptic potentials in the EEG and the interval between stroke and the first seizure. During follow-up 27 patients suffered a recurrent stroke, and 52 patients died. Cardiac failure was the predominant cause of death; only 4 patients died as a consequence of an epileptic fit.

Key words

Cerebral infarction Epilepsy Computed tomography 


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  1. 1.
    Annegers JF, Grabow JD, Groover RV, Laws ER, Elveback LR, Kurland T (1980) Seizures after head trauma: a population study. Neurology 30:683–689Google Scholar
  2. 2.
    Barolin GS, Reinisch H (1972) Autoptische Befunde bei vaskulären Epilepsien. Wien Z Nervenheilkd 30:8–24Google Scholar
  3. 3.
    Barolin GS, Scherzer E, Schnaberth G (1975) Die zerebrovaskulär bedingten Anfälle. In: Kielholz P, Kaeser H, Klingler M (eds) Aktuelle Probleme in der Psychiatrie, Neurologie, Neurochirurgie, vol 12. Huber, BernGoogle Scholar
  4. 4.
    Cerebral Embolism Task Force (1986) Cardiogenic brain embolism. Arch Neurol 43:71–84Google Scholar
  5. 5.
    Cocito L, Favale E, Reni L (1982) Epileptic seizures in cerebral arterial occlusive disease. Stroke 13:189–195Google Scholar
  6. 6.
    DeCarolis P, Alessandro RD, Ferrara R, Andreoli A, Sacquegna T, Lugaresi E (1984) Late seizures in patients with internal carotid and middle cerebral artery occlusive disease following ischaemic events. J Neurol Neurosurg Psychiatry 47:1345–1347Google Scholar
  7. 7.
    DeReuck J, Krahel N, Sieben G, Orban L, DeCoster W, Vander Eecken H (1980) Epilepsy in patients with cerebral infarcts. J Neurol 224:101–109Google Scholar
  8. 8.
    Dodge PR, Richardson EP, Victor M (1954) Recurrent convulsive seizures as a sequel to cerebral infarction: a clinical and pathological study. Brain 77:610–638Google Scholar
  9. 9.
    Fine W (1967) Post-hemiplegic epilepsy in the elderly. Br Med J 10:199–201Google Scholar
  10. 10.
    Fischer H (1959) Symptomatische Epilepsie bei zerebralen Gefäßprozessen. Arch Psychiatr Nervenkr 199:296–310Google Scholar
  11. 11.
    Gupta SR, Naheedy MH, Elias D, Rubino FA (1988) Postinfarction seizures — a clinical study. Stroke 19:1477–1481Google Scholar
  12. 12.
    Heiss WD, Hayakawa T, Waltz AG (1976) Cortical neuronal function during ischemia — effects of occlusion of one middle cerebral artery on single unit activity in cats. Arch Neurol 33:813–820Google Scholar
  13. 13.
    Jennet B (1979) Posttraumatic epilepsy. Adv Neurol 22:137–147Google Scholar
  14. 14.
    Johnson HC, Walker AE (1951) The angiographic diagnosis of spontaneous thrombosis of the internal and common carotid arteries. J Neurosurg 8:631–643Google Scholar
  15. 15.
    Kehrer HE, Aretz U (1963) Epileptische Anfälle bei zerebraler Gefäßsklerose — ein Beitrag zur Pathogenese der „Spätepilepsie“. Psychiatr Neurol 146:265–272Google Scholar
  16. 16.
    Knuepling R, Schliack H (1972) Epileptische Anfälle bei cerebralen Durchblutungsstörungen. Z Neurol 201:196–200Google Scholar
  17. 17.
    Krayenbühl H, Yasargil MG (1964) Verschluß der Arteria cerebralis media — Ergebnisse der klinischen und katamnestischen Untersuchungen. Schweiz Arch Neurol Neurochir Psychiatr 94:287–296Google Scholar
  18. 18.
    Lange SC, Neafsex ES, Wiler AR (1980) Neuronal activity in chronic ferric chloride epileptic foci. Epilepsia 21:251–254Google Scholar
  19. 19.
    Louis S, McDowell F (1967) Epileptic seizures in nonembolic cerebral infarction. Arch Neurol 17:414–418Google Scholar
  20. 20.
    Moskowitz E, Lightbody FEH, Freitag NS (1972) Long-term follow-up of the poststroke patient. Arch Phys Med Rehabil 53:167–172Google Scholar
  21. 21.
    Richardson EP, Dodge PR (1954) Epilepsy in cerebrovascular disease — a study of the incidence and nature of seizures in 104 autopsy-proven cases of cerebral infarction and hemmorhage. Epilepsia 3:49–65Google Scholar
  22. 22.
    Shinton RA, Gill JS, Melnick SC, Gupta AK, Beevers DG (1988) The frequency, characteristics and prognosis of epileptic seizures at the onset of stroke. J Neurol Neurosurg Psychiatry 51:273–276Google Scholar
  23. 23.
    Silverstein A (1959) Occlusive disease of the carotid arteries. Circulation 20:4–12Google Scholar
  24. 24.
    Willmore LJ, Sypert GW, Munson SB (1978) Recurrent seizures induced by cortical injection: a model of post traumatic epilepsy. Ann Neurol 4:329–336Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • Claus R. Hornig
    • 1
  • Thomas Büttner
    • 1
  • Andreas Hufnagel
    • 1
  • Karl Schröder-Rosenstock
    • 1
  • Wolfgang Dorndorf
    • 1
  1. 1.Department of NeurologyJustus Liebig UniversityGiessenGermany

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