Abstracts

Rationale: Seizures in stroke are not uncommon in clinical practice. But little is known about the differences between seizures at stroke presentation (SSP) and seizures during hospitalization (SDH), and their impacts on outcome. Methods: This cohort study included consecutive patients with acute ischemic stroke between July 2003 and March 2008 from the Registry of the Canadian Stroke Network. Main outcome measures included morbidity (modified Rankin Scale), mortality with 30 days and one year, length-of-stay, and discharge disposition. Stroke outcome in SDH stratified by stroke severity was analyzed. Logistic regression analysis was used. Results: A total of 10,261 patients with ischemic strokes were recruited; 157 (1.53%) patients had SSP and 208 (2.02%) patients had SDH. Compared to their counterparts without seizures, both SSP and SDH had significantly lower Canadian Neurological Scale (CNS) score (p<0.00001), were less common in lacunar syndrome (8.3% vs 17.3%, 8.2% vs 17.3%, p<0.00001), higher admission rate to ICU (21.7% vs 8.0%, 20.7% vs 8.0%, p<0.00001), higher morbidity (p=0.0439) and mortality (p<0.00001), and more dispositions to acute care (p<0.0017). Importantly, patients with less severe strokes (CNS score>5) had significantly higher morbidity and mortality within 30 days and 1 year (p = 0.00001 to 0.0049), if SDH occurred. Variables predicting overall mortality were SDH, older age, higher Charlson index, lower CNS score and non-alert status on arrival (all p<0.0001). Conclusions: Although both SSP and SDH in ischemic strokes are associated with younger age, severe strokes, and higher morbidity and mortality, they show different characteristics. SDH aggravate prognosis in patients, especially in those with less severe strokes. Increased awareness of SSP and prevention of SDH would be important in clinical stroke care.