Seizure After Ischemic Stroke; A Diagnostic and Management Challenge in a Resource Limited Setting: A Case Report

Background: Poststroke seizures occur in 6-8% of the adult population that suffer an ischaemic stroke. This pathological process increases metabolic stress and cell death, the extent of vascular obstruction in the brain, the mortality rate and long term morbidity. Poststroke seizures represent one of the most important complications of stroke that must be recognised and treated in a timely fashion. These are classified as either early or late depending on the time of onset after stroke. Case Report: A 51 year old woman presented to the Emergency Department of RSUD Dr Murjani following a generalised tonic-clonic seizure 3 hours prior that had lasted for two minutes. On arrival the patient subsequently had two further generalised tonic-clonic seizures with a one hour interval between. Whole body stiffness and a fixed upward gaze were observed. A non-contrast CT Head displayed a diffuse infarct of the left frontotemporoparietooccipital lobes. The patient had a history of stroke one year previously and a second stroke one month ago with resultant persistent weakness of the right upper and lower limbs. This patient was diagnosed with poststroke seizure of late onset and treated in hospital with diazepam 10mg and phenytoin 100mg three times per day. Discussion: Poststroke seizure is described as either early-onset (occurring in the first week after a stroke) or late-onset (occurring after the first week). Based on the International League Against Epilepsy (ILAE) definition, a single unprovoked late-onset poststroke seizure occurring more than seven days after a stroke is considered as epilepsy with a high risk (>60%) of recurrent seizures that may occur for up to ten years thereafter. Hence this risk factor must be identified and treated correctly to prevent significantly increased morbidity for the patien