Cerebrovascular disease can also be secondary to seizures, this article is a complete summary

Cerebrovascular disease can cause seizures, and often become the first symptom of its onset, at the same time seizures can also cause cerebrovascular diseases, thereby bringing difficulties to diagnosis and treatment, and obviously affecting the prognosis of patients, the author summarizes the causes and characteristics of cerebrovascular diseases caused by seizures, for your reference
.

Author: Yuan Weizhe (Resident, The Second Affiliated Hospital of Hebei Medical University).

This article is authorized by the author to be published by Yimaitong, please do not reprint
without authorization.

Seizures in cerebral infarction

➤ Incidence rate: The incidence of epilepsy after cerebral infarction has been reported
differently.
Rochester's study found that 6% of patients with cerebral infarction develop epilepsy within 1 week of onset; However, head CT scans of 132 patients with late-onset epilepsy without a history of cerebral ischemia have been found that 15 patients have cerebral infarction and 9 patients have lacunar infarction
.
Sung and Chu studied 118 patients with cerebral thrombosis with epilepsy and found that 22% had no history of typical stroke, and there were resting infarcts on CT, and pointed out that such resting infarcts were an important cause of
epilepsy.
Therefore, the incidence of epilepsy after cerebral infarction may be higher than reported in the literature, most tend to 8%~27%.

Cerebral thrombosis is less likely to occur than
cerebral embolism.

➤ Types of cerebral infarction: Various types of cerebral infarction can cause seizures
.
Cortical venous sinus thrombosis confirmed by head CT scan and cerebral angiography can cause seizures
in newborns.
Although venous infarction causes much fewer seizures than arterial infarction, it often causes many types of intractable seizures
in newborns, children, and women during pregnancy and the puerperium.
Lacunar infarction can be the only manifestation
of epilepsy.

➤ Age and gender: Cerebral infarction of all ages can cause seizures
.
An analysis of 150 neonates with seizures found cerebral ischemia to be the most common cause; Multiple types of recurrent seizures in childhood may be venous thrombosis; Older people are the most likely age for cerebral infarction and the most prone to
seizures.
Cerebral infarction is often the most common cause of
senile epilepsy.
Cortical vein thrombosis should be considered
in pregnant women, especially those with various partial seizures within 2 weeks of delivery, accompanied by lethargy or coma.

➤ The influence of the location and degree of cerebral infarction on seizures: cortical and subcortical infarctions, especially from the cortical wave to the subcortical deep infarction, have a tendency to induce epilepsy, but the relationship between occlusion of different blood vessels and seizures is inconclusive
.
In a study of 100 cases of post-cerebral infarction epilepsy, Hornig et al.
found that 75% were isolated middle cerebral artery occlusion, 6% were posterior cerebral artery or watershed infarction, and some people thought that different cerebrovascular infarctions were not related
to seizures.

➤Types of seizures in cerebral infarction: Cerebral infarction can cause almost all forms of seizures, and most have no seizure aura
.
But 54% of these were site-related epilepsy, particularly the motor cortex
.
In a study of 118 patients in Taiwan, Sung found that 56% of them were simple partial seizures and 24% were complex partial seizures; A small number of beneficiaries may present with tonic-paroxysmal seizures or vegetative states, and other types of seizures, such as Jackson's partial seizures secondary to generalized seizures, may occur
in anterior circulation infarctions.

➤ Time of epilepsy after cerebral infarction: Cerebral thrombosis occurs in two periods
of 2 weeks and 6-12 months after stroke.
Epileptic seizures within 1 year after stroke can reach 71%-73%, 2% of seizures occur after 2 years, and 2% of seizures occur in the early stage mainly partially or partially secondarily generalized, 35% of patients have recurrent seizures later, mainly generalized seizures occur in the late stage, and 90% of patients recur later, which may be related
to the different pathogenic mechanisms of early onset and late onset.

➤Treatment and prognosis of epilepsy after cerebral death: In addition to the application of drugs for the treatment of cerebral infarction, acute seizures do not need to be treated with anti-epileptic drugs for severe cases, especially for longer patients, phenytoin can be selected, and the epileptic state that occurs during acute is still selected diazepam or phenobarbital, due to the destruction of the blood-brain barrier here, the amount of drugs ingested in the brain after medication can be 2-3 times higher than normal for seizures that need to be treated with antiepileptic drugs, which can generally be treated
as secondary epilepsy.

Epileptic seizures due to cerebral infarction can worsen the prognosis in the first 2 days after stroke, but subsequent seizures have less
prognosis.
Under antiepileptic treatment, 3/4 of patients have no more than 2 seizures per year, 88% can be satisfactorily controlled with only one antiepileptic drug, and only 3% of patients have refractory focal epilepsy, and very few die of seizures
.

Seizures in intracerebral hemorrhage

➤ Incidence rate: The incidence of epilepsy in cerebral hemorrhage is related
to the length of follow-up.
Some people found that the incidence of epilepsy was 46% in the follow-up of 1402 patients, and Bergr et al.
found that the incidence of epilepsy was 17%
in 112 patients.

➤ Effect of bleeding site on seizures: The occurrence of epilepsy in cerebral hemorrhage is obviously related to the bleeding site, and the incidence of bleeding in the cerebral lobar cortex or involving the cerebral lobar cortex is much higher
than that of hemorrhagic epilepsy in non-cortical sites.
32%-54% of the seizures caused by cerebral hemorrhage occur in lobar hemorrhage, especially temporal and parietal cortex damage, basal ganglia hemorrhage accounts for 19%, mainly caused by damage to the legume nucleus and caudate nucleus, and thalamus, pons, cerebellar hemorrhage rarely occurs
.
Although the proportion of epileptic episodes in intracerebral hemorrhage is higher, there are fewer
recurrent authors.

➤ The effect of bleeding volume on seizures: The relationship between the size of bleeding and epilepsy is unclear, some people think that hematoma size is not related to seizures, and others think that small lobar hemorrhages are more likely to occur epilepsy
.

➤ Types of seizures and timing of bleeding: Intracerebral hemorrhage can cause generalized, partial, partially secondary generalized seizures and epileptic states
.
Movement seizures are more common
in simple partial seizures.
Generalized seizures are predominant
with tonic-clonic or tonic seizures.
More than half of the seizures occur within 24 hours of onset, 1/3 take epilepsy as the first symptom, more than 90% of the seizures within 1 year after the onset, patients without seizures in the acute stage, the risk of subsequent seizures is significantly reduced

➤ Treatment: Since most seizures appear in the acute phase of cerebral hemorrhage, the chance of repeated attacks is not large, so preventive medication is not necessary
.
Authors of recurrent episodes need to use antiepileptic drugs to control seizures
.

Seizures in subarachnoid hemorrhage

Seizures occur in 10% to 24% of subarachnoid hemorrhages or after surgery, which can occur within 2 years of bleeding to bleeding, mostly within 24 hours of bleeding, but the Oxford stroke team in the UK reported that 10% of epilepsy patients with subarachnoid haemorrhage occurred within 2 weeks of onset, and the remaining patients appeared within 6 months
of onset.
Can be systemic or partial seizures, motor seizures alone have no definite value for aneurysm, and patients with hypertension and coma have a greater
chance of developing epilepsy.
Seizures after surgery may be related to
cerebral infarction.
Antiepileptic drugs are generally advocated for more than 1 seizure in the acute phase, but because survivors with seizures in the acute phase have less chance of developing epilepsy in the future, long-term preventive medication is also unnecessary
.

Seizures in cerebrovascular malformations

Seizures in cerebrovascular malformations include symptomatic epilepsy that accompanies the vascular malformation itself, or epilepsy
complicated by surgery for cerebrovascular malformations.
Vascular malformations that present symptoms earlier have a higher
probability of developing epilepsy.
The location of cerebrovascular malformation is obviously related to the incidence of epilepsy, and the order of predisposition of each brain lobe is temporal lobe, parietal lobe, frontal lobe, and occipital lobe
.
Epilepsy caused by supratentorial vascular malformations is mostly focal.
It can be simple or complex partial or partially secondary generalized seizures
.
Complicated by intracerebral hemorrhage or subarachnoid hemorrhage, often causes generalized tonic-clonic seizures
.
Among the different types of vascular malformations, cavernous vascular malformations have a higher probability of causing epilepsy, accounting for 23%-51%, and the age of incidence is 20-30 years old; 20%-37% of arteriovenous malformations are accompanied by epilepsy, and the incidence is 13-16 years; Seizures
occur in 7% to 33% of cerebral arteriovenous malformations.

Seizures in other cerebrovascular diseases

Seizures are less common
in other cerebrovascular diseases.
Arteriovenous malformations, aneurysms, cavitary hemangiomas, certain hidden malformations in the cortex, and concomitant injury can cause seizures
.
Between 20% and 37% of arteriovenous malformations are associated with epilepsy, and the incidence is almost equal
in men and women aged 13 to 16 years.
Arteriovenous malformations with seizures are mostly located in or near the cortex, mostly in the temporal and frontal lobes, followed by the parietal lobe
.
No reports of arteriovenous malformations located in the cerebellum with epilepsy
.
The seizure type is mainly partial, especially complex partial seizures, and generalized or partially secondary generalized seizures have also been reported
.

brief summary

Cerebrovascular disease complicated by seizures is a common clinical disease, as a neurologist in the clinical encounter with this situation do not panic, should be early identification and judgment, and take effective treatment measures, so as to save the patient's life
.