Open AccessPearls & Oy-sters: De Novo Seizure and Stroke in the Elderly
Author(s) -
Christo Bratanov,
Loïc Legris,
Guillaume Martin
Publication year - 2022
Publication title -
neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.674
H-Index - 29
eISSN - 1526-632X
pISSN - 0028-3878
DOI - 10.1212/wnl.0000000000200119
Subject(s) - medicine , epilepsy , stroke (engine) , leptomeninges , magnetic resonance imaging , cardiology , magnetic resonance angiography , vascular disease , anesthesia , radiology , psychiatry , central nervous system , mechanical engineering , engineering
Seizures immediately preceding the occurrence of an ischemic or hemorrhagic stroke are a rare but well-documented phenomenon, for which the term “heraldic seizure” has been proposed. Cerebrovascular disease is the most common cause of epileptic seizures in elderly patients; thus, screening and management of vascular risk factors should be performed systematically in cases of late-onset epilepsy. MRI may help to distinguish heraldic seizure from stroke-elicited seizure by showing abnormalities confined to the cortex that spare vascular territories, increased magnetic resonance angiography flow in the ipsilateral cerebral arteries, and enhancement of the leptomeninges on postcontrast MRI. We present a case report that illustrates the difficulty of making the diagnosis of a heraldic seizure at onset.