Seizure is very rarely associated with true ischemic stroke; the presence of seizure is, in fact, a contraindication for administering t-PA in patients thought to have had a stroke.
Thus, when patients present with an alleged stroke in the setting of seizure, be skeptical as to whether there truly was an ischemic stroke and do more investigating to ascertain a satisfactory conclusion. In these cases, perhaps the patient suffered a hemorrhagic stroke, which is associated with seizure more often than is ischemic stroke.
Post-seizure sequelae can present as focal neurologic deficit that mimics stroke (i.e. Todd's Paralysis), but note that these are generally associated with partial, not generalized, seizures.
Finally, remember that patients who have had strokes in the past are at increased risk for having future strokes AND for developing a seizure disorder secondary to the focal area of brain tissue damaged by their prior stroke. These patients, therefore, may present with a combination of true, new OR exacerbated, old stroke symptoms, with or without seizure.
