Researchers at The Children’s Hospital of Philadelphia, PA, determined the incidence of seizures as a presenting symptom of acute arterial ischemic stroke (AIS) in children and identified risk factors for seizures. Among 60 children aged 2 months to 18 years with AIS, 13 presented with seizures (22%), focal in 10. Of 47 children not presenting with seizures, only 2 had clinical seizures later in the hospitalization period. Seizure was the heralding sign of stroke onset in children presenting with seizures, preceding other focal neurologic signs and symptoms. Younger age was a risk factor for seizures at presentation (1.1 years with seizures vs 10 years with no seizure; p=0.0009). Occurrence of seizures was not associated with infarct location or etiology. All patients with seizures had hemiparesis. Three of 4 children with clinical seizures also had nonconvulsive seizures on continuous EEG monitoring at presentation. 
COMMENT. Stroke should be considered in a child presenting with new-onset seizure in combination with focal neurologic deficits. Seizures are rare during acute hospitalization for AIS if they do not occur at presentation, and prophylactic anticonvulsant therapy is probably not warranted. Nonconvulsive seizures, detected by continuous EEG monitoring, may be an under-recognized complication of AIS, and EEG should be considered in patients with impaired consciousness.