Medicine (RMH) - Theses

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Author: Chen, Ziyuan × End date: 2019 × Type: Masters Research thesis ×

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    Correlation of the extent of ischemia assessed by aspects with post stroke seizures
    Chen, Ziyuan ( 2016)
    Background: Ischemic stroke is a common cause of secondary seizures. Cortical involvement of ischemic stroke and large ischemic lesion size are amongst the most consistently reported risk factors for post stroke seizures. Alberta Stroke Program Early CT Score (ASPECTS) is a simple and reliable tool for quantifying the extent of cerebral ischemia and may function as a screening tool for patients at high risk of seizure development. We investigated the association of post stroke seizures with the extent of ischemia assessed by ASPECTS and with cortical involvement visualized on non-contrast CT. Methods: This cohort study was based on a prospectively maintained clinical database of acute ischemic stroke patients who were given intravenous tissue plasminogen activator treatment. We included patients with anterior circulation stroke admitted between January 2008 and October 2014. Patients with pre-stroke seizures were excluded. Clinical data and seizure follow-up data were collected. Non-contrast CT scans acquired both on admission and at 24 hours were analyzed. Logistic regression, survival analysis and receiver operating curve analysis were performed. Results: A total of 348 patients were included. The median age was 73 (inter-quartile range [IQR] 63-80) and 55% were male. During follow-up (median duration 559 days, IQR 107.5-1188.5 days), 22 (6.3%) patients developed post stroke seizures. Median time from stroke to seizure onset was 138 days (IQR 10-342 days). In univariate logistic regression, both ASPECTS on admission (odds ratio [OR] 0.69 per 1-point increase; 95% confidence interval [CI] 0.55-0.86; p=0.001) and at 24 hours (OR 0.80 per 1-point increase; 95% CI 0.70-0.92; p=0.002) were significantly associated with post stroke seizures. Cortical involvement at 24 hours also correlated with seizure occurrence (OR 3.01; 95% CI 1.08-8.34; p=0.03). Cox regression confirmed the higher risk of developing seizures at any time point in patients with lower ASPECTS value and cortical involvement. Of note, ASPECTS was the only independent predictor for post stroke seizures in multivariate logistic regression. Conclusion: The extent of ischemia assessed by ASPECTS and cortical involvement identified on non-contrast CT were associated with the development of post stroke seizures.