Aim: To analyze the risk and role of acute symptomatic seizure and hippocampal sclerosis in the development of post-stroke epilepsy. Study Design: Retrospective study. Place and duration of study: Department of Neurology, Gujranwala Medical College, Gujranwala from 1st July 2021 to 31st December 2021. Methodology: One hundred patients were enrolled on the basis of acute ischemia or hemorrhagic stroke occurrence. These two conditions were confirmed through MRI imaging. Atrophy formation,

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... ons in signals visibility in T1 as well as T2 weighted-sequences in addition to internal architecture loss with atrophy of hippocampal was the MRI criteria for diagnosis of hippocampal sclerosis. A control group was also generated of fifty patients to assess the clinical diagnostics of hippocampal sclerosis patients against normal controls. Results: There were 57% males and 43% females with a mean age of 74.2±13.2 years. Ischemia was seen in 40% of the cases while hemorrhagic stroke was present in 62% of all the patients enrolled. Acute symptomatic seizures were present in 30 cases while it was not observed in 70 other cases. The EEG of hippocampal sclerosis presented fronto-parietal stroke and left parieto-temporal strokes while in controls with majority as cerebral venous sinus thrombosis, in addition to basal ganglia hemorrhage. Conclusion: Acute hemorrhage from stroke in combination with the acute and symptomatic seizure results into epileptic episodes and in many cases to secondary formation of hippocampal sclerosis. Keywords: Acute symptomatic seizures (ASS), Hippocampal sclerosis, Post-stroke epilepsy