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What's the Difference between a Seizure & a Stroke?

Learn the difference between a seizure and a stroke from Steve Wolf, MD and Patty McGoldrick, NP in this Howcast video.


Speaker 1: Many people, when they witness a seizure, after the seizure they'll notice that the patient will have some weakness on one side or the other. They're concerned that this could be from a stroke. But we know it's something called a Todd's paralysis.

Speaker 2: Right. This occurs after a seizure, usually after a complex partial seizure. It can also occur in episodes of benign rolandic epilepsy, which are the seizures that occur out of sleep in children. The child or the adults will be left with a weakness of one, usually left or right arm. Not so much the legs.

Speaker 1: What's nice about these kinds of weaknesses is they will resolve. They typically resolved within a few minutes. Sometimes it can last an hour or two after a seizure. But they shouldn't be any more than 24 hours because then that would be more likely associated with a stroke.

Speaker 2: The problem is differentiating. When do you decide that you need to seek medical care and go to the emergency room and when do you feel like it's just something you handle at home. This is where a discussion with your doctor or your nurse practitioner ahead of time, so that you're aware that this may happen, know not to panic, and to know who to call and who to discuss it with is a very useful conversation.

Speaker 1: Don't be surprised if this is your first time witnessing a seizure and there is some focal weakness in an arm or a leg. You are probably going to get a picture of your brain in the emergency room. You should be evaluated in the emergency room for that first episode. But for future seizures, if everything is perfectly fine after that emergency room visit, you might notice that this is going to be a repetitive thing, this might happen. Especially in young children after a seizure.

Speaker 2: This is part of the seizure. It will go away and it will get better. You don't need to run off to the emergency room.

Speaker 1: So strokes and seizures can look alike early on. It's called a Todd's paralysis. Usually it will resolve right after a seizure as where a stroke will not. A stroke should show up on some imaging study in the emergency room that will show a hole or something abnormal.

But again, what you're hoping is after the seizure, the weakness will just get better.

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