Seizure - transient occurrence of signs or symptoms due to abnormal excessive or synchronous

neuronal activity in the brain. Depending on the distribution of discharges, this abnormal brain
activity can have various manifestations, ranging from dramatic convulsive activity to experiential
phenomena not readily discernible by an observer.

CLASSIFICATION OF SEIZURES
Determining the type of seizure that has occurred is essential for focusing the diagnostic approach on
particular etiologies, selecting the appropriate therapy, and providing potentially vital information
regarding prognosis. The International League Against Epilepsy (ILAE) Commission on Classification
and Terminology provided an updated approach to classification of seizures in 2017 (Table 418-1).
This system is based on the clinical features of seizures and associated electroencephalographic
findings.

When to suspect Cardioembolic Infarct?

Cardioembolism is responsible for ~20% of all ischemic strokes. Stroke caused by heart disease is
primarily due to embolism of thrombotic material forming on the atrial or ventricular wall or the left
heart valves. These thrombi then detach and embolize into the arterial circulation. The thrombus may
fragment or lyse quickly, producing only a TIA. Alternatively, the arterial occlusion may last longer,
producing stroke. Embolic strokes tend to occur suddenly with maximum neurologic deficit present at
onset. With reperfusion following more prolonged ischemia, petechial hemorrhages can occur
within the ischemic territory. These are usually of no clinical significance and should be distinguished
from frank intracranial hemorrhage into a region of ischemic stroke where the mass effect from the
hemorhage can cause a significant decline in neurologic function.

Emboli from the heart most often lodge in the intracranial internal carotid artery, the MCA, the
posterior cerebral artery (PCA), or one of their branches; infrequently, the anterior cerebral artery
(ACA) is involved. Emboli large enough to occlude the stem of the MCA (3–4 mm) or internal carotid
terminus lead to large infarcts that involve both deep gray and white matter and some portions of the
cortical surface and its underlying white matter. A smaller embolus may occlude a small cortical or
penetrating arterial branch. The location and size of an infarct within a vascular territory depend on
the extent of the collateral circulation.
The most significant cause of cardioembolic stroke in most of the world is nonrheumatic (often called
nonvalvular) atrial fibrillation. MI, prosthetic valves, rheumatic heart disease, and ischemic
cardiomyopathy.

When is intracerebral bleed surgical?

Possible treatments of acute ICH include: (1) slowing or stopping of the bleeding during the first
several hours after onset or (2) removal of the accumulated hematoma to prevent the mechanical
complications of mass effect as well as the toxic effects of blood on the surrounding brain
parenchyma. 

Surgical treatment versus medical therapy

Factors that favour medical therapy

 Large haemorrhage with moribund patient (GCS < 5)
 Orientated patient with small haematoma (< 2 cm)

Factors that favour surgical removal of the haematoma

 Superficial haemorrhage
 Clot volume between 20-80 ml
 Supratentorial superficial lobar hemorrhages of >30 cc in volume
 Worsening neurological status
 Relatively young patients
 Haemorrhage causing midline shift/raised ICP
 Cerebellar haematomas > 3 cm or causing hydrocephalus