Epilepsy and Trauma / Stroke

Question 1

Post-traumatic seizures: Factors increasing risk for developing epilepsy (and one that doesn’t)

Answer 1

1. Late (after first week) - 86%
2. Seizures in combination with moderate or severe TBI
3. Epileptiform discharges on EEG doesn’t necessarily increase likelihood of epilepsy

Question 1

Types of post-traumatic seizures (2) and relative risk of epilepsy

Answer 1

Early (within first week): 10%
Late (after first week): 86%

Question 2

Seizure prophylaxis in head injury

Answer 2

Mixed, but AAN recommends 1-week treatment in ADULTS with SEVERE brain injury
Not in children

Question 3

Likelihood of Seizures as presenting symptom of stroke in:
Neonates
Children
Adults

Answer 3

Neonates - 80%
Children - 30%
Adults - Rare (no percentage in book)

Question 4

Risk of epilepsy after stroke in
Pediatric
Adult

Answer 4

Pediatric: up to 40%
Adult: 5%

Question 5

Classification of Post-stroke seizure and why

Answer 5

Early (within first week)
Late (after first week)
- even one late post-stroke seizure has high risk of recurrence >50%

Question 6

Board “buzz word” classic EEG finding in stroke

Answer 6

Lateralized period discharges (LPDs, formerly PLEDS)

Question 7

Classification of Traumatic brain injury (Mild, moderate, severe) based on :
Duration
Presence of structural brain injury

Answer 7

Question 8

• Most common malformations associated with Epilepsy (2)
• Common Malformation NOT associated with seizures
• Other factors increasing suspicion for causing seizures (3)

Answer 8

Most common malformations to cause seizures:
- Arteriovenous malformations (AVM)
- Cavernous malformations
Developmental venous anomalies (DVAs) are typically incidental
Factors increasing epileptogenic risk
- surrounding hemorrhage
- gliosis
- encephalomalacia

Question 9

5-year risk for seizure in incidentally diagnosed Vascular malformations
- AVM
- AVM + hemorrhage
- AVM in temporal lobe
- CM
- CM + Hemorrhage
- CM in temporal lobe

Answer 9

• AVM: 8%
• AVM + Hemorrhage: 23%
• AVM in temporal lobe: increased risk
• CM: 4-6%
• CM+ hemorrhage: 4-6%
• CM in temporal lobe: no increased risk

Question 10

Developmental venous anomalies (and presenting symptom):
% incidental (on MRI)
% with focal neurologic deficits
% with symptomatic bleeding
% with seiuzures
% unclear

Answer 10

% incidental: 61%
% with focal neurologic deficits: 6%
% with symptomatic bleeding 6%
% with seizures 4%
% unclear: 23%