Introduction New onset seizures are an uncommon, but morbid sequelae of acute ischemic stroke. The reported incidence has a wide range, as studies on the topic vary significantly in inclusion criteria. Similarly, heterogeneity in studied patient populations has led to a lack of consensus on risk factors. Here we report the incidence and risk factors of new onset seizure after ischemic stroke in a single institution.

Methods We retrospectively identified all patients who were admitted to Harborview Medical Center with a diagnosis of ischemic stroke from 2018 to 2022. Pediatric patients and patients with a history of seizures were excluded from analysis. Patient charts were then reviewed for clinical history, etiology of stroke, characteristics of stroke, including size and location, severity of stroke by NIHSS at admission, treatment of stroke, presence of hemorrhagic transformation, and post-stroke seizure development.

Results A total of 1307 patients met inclusion criteria, with a median age of 69 (18-101). Forty-two percent of patients were female. The incidence of post-stroke seizures was 8.5%. The incidence of early (≤ 7 days) and late (>7 days) onset post-stroke seizures was 4.7% and 4.6%, respectively. On univariate analysis, age (p<0.01), presence of hemorrhagic transformation (p=0.02), and type of hemorrhagic transformation (p=0.01) were significantly associated with development of post-stroke seizures. The type of hemorrhagic conversion driving the association was intraparenchymal hemorrhage (IPH); petechial hemorrhage was not significantly predictive of post-stroke seizures (p=0.46).

Discussion The literature on new onset seizures after stroke describes a range of incidences and risk factors, as there is variation in the studied populations. Here we report the incidence of post-stroke seizures in all patients diagnosed with ischemic stroke in a 3-year period. The most significant predictor was hemorrhagic transformation, and this was driven by IPH.

Disclosures K. Carroll: None. E. Federico: None. I. Stafstrom: None. E. Skinner: None. M. Maraghe: None. M. Levitt: None.