Qatar’s population is unique, comprising of natives and immigrants. We aimed to describe types and radiological characteristics of strokes presenting with seizures in this distinct mixed population.

In the current age of thrombolysis and endovascular interventions for ischemic stroke, identifying stroke as a cause of seizure poses a challenge to physicians. Certain etiologies of stroke are more likely to present as seizures than others.

We carried out a retrospective electronic medical record chart review of all patients admitted with stroke diagnosis, between January 2014 and December 2018. We identified patients presenting with seizures. We reviewed Neurology notes, discharge summaries and imaging to characterize both stroke and seizures.

Among 4987 strokes, 3954 (79%) were classified as ischemic stroke (IS), 948 (19%) intracranial hemorrhage (ICH) and 85 (2%) as cerebral venous sinus thrombosis (CVST). Sixty-eight patients (1.4%) had seizures at presentation; 26 of IS (0.7%), 25 of ICH (2.6%); and 17 of CVST (20%). Fifty-two (76.5%) were males. Average age was 47.3 years (18-82). Out of IS, 18(69.2%) involved anterior circulation, 2(7.7%) posterior circulation, 3 (11.5%) both, and 3 (11.5%) watershed areas. Among 25 ICH, 11 (44%) involved typical sites of hypertensive hemorrhage (brainstem:4, cerebellum:1, and basal ganglia/thalamus:6).Another 14(56%) of ICH involved lobes, of those 5(36%) were due to vascular malformations. Among 17 CVST, 10 (58.8%) showed hemorrhage or hemorrhagic infarction. Seven subjects (10.3%) had convulsive status epilepticus; 1(14.3%) with IS, 2(28.6) with ICH and 4 (57.1) with CVST.

To our knowledge, this is the first study of strokes presenting as seizures in adults in the Middle East. CVST is the most common type of cerebrovascular event likely to present with seizures and status-epilepticus. A small number of patients with other types of strokes also have seizure as a heralding symptom.