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Early Post-Stroke Seizure — SCE Neurology MCQ

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ModerateCerebrovascular DiseaseEarly Post-Stroke SeizureSCE Neurology

A 50-year-old man with no previous neurological history collapses at work. Witnesses describe initial left arm jerking followed by bilateral convulsive movements. Post-ictally, he has a left homonymous hemianopia and right-sided neglect. CT head shows a large right MCA territory ischaemic infarct with early haemorrhagic transformation. What term describes his seizure?

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Correct answer: E — Early post-stroke seizure

Early post-stroke seizures occur within 7 days of the stroke. They are considered acute symptomatic (provoked) seizures and do not, in isolation, constitute a diagnosis of epilepsy (which requires 2 unprovoked seizures or 1 unprovoked seizure with high recurrence risk). The focal onset (left arm) followed by bilateral convulsive movements is consistent with a focal to bilateral tonic-clonic seizure from the right hemisphere infarct. A: Late post-stroke epilepsy is defined as seizures occurring >7 days post-stroke. C: The seizure terminated, so it was not SE. D: The cause is structural, not metabolic. E: The clinical and radiological findings confirm an epileptic seizure.

Reference: NICE NG217 (2025); ILAE Definitions