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Cerebrovascular disease is a well-known cause of epilepsy. Multiple investigators have also reported that an onset of seizures after middle age can precede stroke [1–8] and the term “heraldic seizures” has been suggested [9]. Several plausible explanations exist; late-onset epileptic seizures may reflect occult cerebrovascular disease, promote isolation and reduced physical activity, or result in treatment with antiepileptic drugs that, in turn, increase cardiovascular risk. Whether late-onset epilepsy should prompt cardiovascular workup and primary prevention of stroke remains uncertain, and there is currently no randomised evidence to guide management.