This Article Full Text Full Text (PDF) All Versions of this Article: 37/3/915    most recent 01.STR.0000202678.86234.84v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sylaja, P.N. Search for Related Content PubMed PubMed Citation Articles by Sylaja, P.N. Pubmed/NCBI databases Medline Plus Health Information CT Scans Paralysis Seizures Stroke Related Collections Acute Cerebral Infarction Emergency treatment of Stroke Thrombolysis

(Stroke. 2006;37:915.)
© 2006 American Heart Association, Inc.

Research Reports

Role of CT Angiography in Thrombolysis Decision-Making for Patients With Presumed Seizure at Stroke Onset

P.N. Sylaja, MD; Imanuel Dzialowski, MD; Andrea Krol; Jayanta Roy, MD; Paolo Federico, MD, FRCPC; Andrew M. Demchuk, MD, FRCPC Calgary Stroke Program

From the Department of Clinical Neurosciences (P.N.S., I.D., A.K., P.F., A.M.D.), University of Calgary, Alberta; and the Advance Medicare & Research Institute (J.R.), Kolkata, India.

Correspondence to Andrew M. Demchuk, MD, FRCPC, Associate Professor, Department of Clinical Neurosciences, University of Calgary, Foothills Medical Centre, Room 1162, 1403 29th St, NW, Calgary, Alberta, Canada. E-mail ademchuk{at}ucalgary.ca

Background and Purpose— The presence of seizure at stroke onset is a contraindication for intravenous tissue plasminogen activator treatment. A significant proportion of these patients’ deficits are not attributable to Todd’s paralysis and could be attributable to reversible ischemia. Currently there are no established methods of differentiating Todd’s paralysis from ischemic stroke/early seizure. We sought to determine whether computed tomographic angiography (CTA) can be helpful in differentiating the 2.

Methods— Three hundred and twenty six patients underwent noncontrast CT and CTA for acute stroke at our institution over 3 years (June 2002 to April 2005). Of them, 116 had disabling deficits and presented within 3 hours. We reviewed the clinical data, noncontrast CT, CTA, electroencephalogram and outcome of these patients and identified those who presented with presumed seizure activity at stroke onset (seizure or altered consciousness at stroke onset).

Results— Nine (7.7%) patients had a concern of seizure at stroke onset. Median age 73 years (range, 31 to 85 years), median National Institutes of Health Stroke Scale (NIHSS) score 12 (range, 5 to 29). CTA showed proximal middle cerebral artery occlusion in 2 and distal middle cerebral artery occlusion in 3 patients. All 5 of these patients had evidence of infarction on follow-up (stroke+early seizure group-intracranial occlusion present). Three of these patients received intravenous tissue plasminogen activator because they were deemed to have "ischemic tissue at risk". Four patients had normal CT and CTA studies and recovered completely in 24 hours (Todd’s paralysis only group-intracranial occlusion negative).

Conclusion— Seizure at stroke onset was relatively uncommon in a consecutive cohort of acute stroke patients. CTA was a useful modality in differentiating Todd’s paralysis from early seizure and ischemia by detection of intracranial occlusion and may contribute to decision-making for thrombolysis.

Key Words: Todd’s paralysis

This article has been cited by other articles:

				C. Iosif, C. Oppenheim, D. Trystram, V. Domigo, and J.-F. Meder MR Imaging-Based Decision in Thrombolytic Therapy for Stroke on Awakening: Report of 2 Cases AJNR Am. J. Neuroradiol., August 1, 2008; 29(7): 1314 - 1316. [Abstract] [Full Text] [PDF]

				C.-Y. Yang, Y.-F. Chen, C.-W. Lee, A. Huang, Y. Shen, C. Wei, and H.-M. Liu Multiphase CT Angiography versus Single-Phase CT Angiography: Comparison of Image Quality and Radiation Dose AJNR Am. J. Neuroradiol., August 1, 2008; 29(7): 1288 - 1295. [Abstract] [Full Text] [PDF]

				J. De Keyser, Z. Gdovinova, M. Uyttenboogaart, P. C. Vroomen, and G. J. Luijckx Intravenous Alteplase for Stroke: Beyond the Guidelines and in Particular Clinical Situations Stroke, September 1, 2007; 38(9): 2612 - 2618. [Abstract] [Full Text] [PDF]

				H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]

				H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]