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- Seizure is very rarely associated with true ischemic stroke; the presence of seizure is, in fact, a contraindication for administering t-PA in patients thought to have had a stroke.
- Thus, when patients present with an alleged stroke in the setting of seizure, be skeptical as to whether there truly was an ischemic stroke and do more investigating to ascertain a satisfactory conclusion. In these cases, perhaps the patient suffered a hemorrhagic stroke, which is associated with seizure more often than is ischemic stroke.
- Post-seizure sequelae can present as focal neurologic deficit that mimics stroke (i.e. Todd's Paralysis), but note that these are generally associated with partial, not generalized, seizures.
- Finally, remember that patients who have had strokes in the past are at increased risk for having future strokes AND for developing a seizure disorder secondary to the focal area of brain tissue damaged by their prior stroke. These patients, therefore, may present with a combination of true, new OR exacerbated, old stroke symptoms, with or without seizure.