Aim To evaluate the imaging features of transcranial Doppler(TCD) in cerebral infarction patients with epileptic seizures during r-tissue-type plasminogen activator(rt-PA) thrombolysis and analyze the risk factors of epileptic seizures. Methods 120 patients with cerebral infarction were selected to the research subjects. All patients received the rt-PA thrombolytic therapy. According to the occurrence of the epileptic seizures, the patients were divided into two groups: epileptic seizures group(53 cases) and simple cerebral infarction group(67 cases). The imaging features of TCD were compared between two groups. The correlations of the clinical factors to the occurrence of the epileptic seizures were analyzed by univariate Logistic regression analysis and multivariate Logistic regression analysis. ResultsTCD examination results showed that the intracranial arterial stenosis, incomplete or occlusion rate was 30.19% and the poor collateral circulation rate was 73.58% in epileptic seizures group. And the intracranial arterial stenosis, incomplete or occlusion rate was 23.88% and the poor collateral circulation rate was 29.85% in simple cerebral infarction group. The collateral circulation in epileptic seizures group was significantly worse than that in simple cerebral infarction group(P＜0.05). The rate of abnormal blood flow velocity was 69.81% in epileptic seizures group, and 32.84% in simple cerebral infarction group, and the difference was significant between the two groups(χ²＝69.20, P＜0.01). Univariate Logistic analysis showed that the ischemic site and NIHSS score were correlated with epileptic seizures(P＜0.05). Multivariate Logistic analysis showed that the cortical ischemia and high NIHSS score were risk factors of epileptic seizures(P＜0.05).Conclusions The cortical ischemia and high NIHSS score were the susceptible factors to cerebral infarction patients with secondary epileptic seizures. In the course of rt-PA thrombolysis, TCD should be applied to inspect the collateral circulation and blood flow velocity and judge the degree of cerebral vascular stenosis, which is as a basis for the treatment of antiepileptic drugs.