Focal motor seizures complicating carotid endarterectomy
J. R. Youkey, G. P. Clagett, J. H. Jaffin, J. E. Parisi and N. M. Rich
We studied four patients with focal motor seizures complicating carotid
endarterectomy and compared them with 14 other cases reported previously.
Seventeen of the 18 patients had high-grade carotid stenoses. A severe
unilateral headache usually preceded seizure activity, which was followed
by prolonged Todd's paralysis. Eight patients had histories of ipsilateral
stroke. There was no association with perioperative hypertension. Two
patients who were receiving heparin sodium had intracerebral hemorrhages
that caused one of the two postoperative deaths. The patency of all
endarterectomized carotid arteries was recorded by arteriography or
noninvasive studies. These data suggest that patients who have severe
unilateral headaches following ipsilateral carotid endarterectomy for
high-grade stenoses are at risk for focal motor seizures. The roles of
antithrombotic agents and anti-seizure medication in this setting are
unclear.
