This study, conducted at Atbara teaching hospital in 2024, will aim to clarify the prevalence of seizures as a presenting symptom of stroke, a critical factor impacting acute management decisions and patient outcomes.

 Stroke is a leading cause of morbidity and mortality globally, with seizures representing a significant complication. This study investigated the frequency of seizures as a first presentation of stroke among patients attending Atbara Teaching Hospital in Nile River State, Sudan, in 2024.

A descriptive, cross-sectional hospital-based study was conducted from February to April 2025. Data were collected via direct interviews with 100 stroke patients using a structured questionnaire, including demographics, medical history, stroke characteristics, seizure types, and results from routine investigations. Data analysis was performed using SPSS 25.0.

Seizures were reported as the initial presenting symptom in 9% of stroke patients. Generalized tonic-clonic (GTC) seizures were the most common subtype (86%), followed by focal seizures (14%). The median age of participants was 62 years (IQR: 51-72), and 60% were male. Hypertension (59%), diabetes mellitus (29%), and ischemic heart disease (11%) were the most prevalent comorbidities. The most frequent locations of stroke were in the middle (26%) and anterior (16%) cerebral artery territories. The average NIH Stroke Scale score was 6.2 ± 2.3; 73% of patients were classified as having a good prognosis (NIHSS >4). No statistically significant association was found between age, gender, or comorbidities with stroke prognosis.

 Seizures as a first presentation of stroke occurred in 9% of patients in this study conducted in Atbara. Generalized tonic-clonic seizures were the most common subtype. A high burden of vascular comorbidities was observed in this population. The lack of correlation between age, gender, comorbidities, and prognosis in this study highlights the need for further research with larger sample sizes.