Patients > 65 years of age with epilepsy represent the most rapidly growing segment of the population. The predominance of cerebrovascular disease and other co-morbidities imply risk for a structural etiology. Focal seizures may commonly be associated with amnesia and mimic other neurological conditions1. In our patient stroke was suspected due to risk factors coupled with a post-ictal focal neurological deficit (Todd’s phenomenon). Carotid endarterectomy was performed with the intraoperative EEG demonstrating a diffuse suppression during clamping created by focal ischemia. Shunting was performed, the EEG resolved, and the patient recovered. Leviteracetam was later begun and he has remained seizure free on a follow-up 24 hour ambulatory EEG. Seizures may be distinguished from TIAs by their paroxysmal brief duration, impaired consciousness, and post-ictal state despite the absence of awareness.
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