Early seizures (within two weeks of stroke) occur in about 5% of patients.80-82 They are more common in haemorrhagic stroke and large infarcts involving the cerebral cortex. Seizures should prompt a review of the diagnosis of stroke (could the focal symptoms be secondary to postictal paralysis or encephalitis?) and a search for precipitating factors (for example, alcohol withdrawal, drugs, metabolic disturbance, or infection). After treating the seizures, we would then reappraise the severity of stroke, since this is notoriously difficult in the presence of seizures. We have occasionally misdiagnosed stroke in patients with non-convulsive seizures, which requires an electroencephalogram for definitive diagnosis. The treatment of poststroke seizures is no different from other forms of secondary epilepsy.83
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