Atherosclerotic cardiovascular disease and myocardial infarctions (MIs) are associated with strokes (and subsequent seizures) in various ways:

  • Atheromata and calcific lesions related to atherosclerosis can precipitate thromboembolic strokes.
  • Reperfusion and thrombolytic or anticoagulant therapy may lead to hemorrhagic strokes.

Large, acute MIs of the anterior and apical wall more commonly are associated with strokes than MIs of the inferior wall.2 The highest risk of embolization is in the first 4 months following acute MI, especially in the first week.3

Although uncommon, seizures can occur in the setting of acute MI, as complications of lobar cerebral hemorrhages with thrombolytic therapy. Rarely, thrombolysis precipitates seizures without evidence of hemorrhage on neuroimaging.4

Cocaine, other CNS stimulants, and intravenous drug use may result in both MI and seizures, with or without identifiable cerebrovascular involvement.

Other systemic vasculitides, such as giant cell arteritis and systemic lupus erythematosus, can also result in seizures and infarctions of both cardiac and cerebral vascular beds.

Left ventricular hypertrophy in the setting of hypertension has recently been associated with increased risk for seizures. A population-based case-control study from Rochester, Minnesota, found that severe uncontrolled hypertension increased the risk for seizure.5 Hypertensive patients who were treated with diuretics did not have an increased risk.

Dilated cardiomyopathy is more associated with cerebral complications than is hypertrophic cardiomyopathy, probably owing to the association of dilated cardiomyopathy with atrial fibrillation.6

Adapted from: Boggs J. Cardiac disorders. In: Ettinger AB and Devinsky O, eds. . Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;39-47. 
With permission from Elsevier (www.elsevier.com). 

Reviewed by: Steven C. Schachter, MD on 2/2004
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