Tonic-Clonic Activity at Subarachnoid Hemorrhage Onset: Impact on Complications and Outcome

被引:10
作者
De Marchis, Gian Marco
Pugin, Deborah
Lantigua, Hector
Zammit, Christopher
Tadi, Prasanna
Schmidt, J. Michael
Falo, M. Cristina
Agarwal, Sachin
Mayer, Stephan A.
Claassen, Jan [1 ]
机构
[1] Columbia Univ, Dept Neurol, Coll Phys & Surg, New York, NY 10027 USA
基金
美国国家卫生研究院; 瑞士国家科学基金会;
关键词
SEIZURES; VASOSPASM; BLOOD; ANEURYSMS; ISCHEMIA; EPILEPSY; RISK;
D O I
10.1371/journal.pone.0071405
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Objective: Tonic-clonic activity (TCA) at onset complicates 3% to 21% of cases of subarachnoid hemorrhage (SAH). The impact of onset TCA on in-hospital complications, including seizures, remains unclear. One study associated onset TCA with poor clinical outcome at 6 weeks after SAH, but to our knowledge no other studies have confirmed this relationship. This study aims to assess the impact of onset TCA on in-hospital complications, poor functional outcome, mortality, and epilepsy at 3 months. Methods: Analysis of a prospective study cohort of 1479 SAH patients admitted to Columbia University Medical Center between 1996 and 2012. TCA within 6 hours of hemorrhage onset was identified based on accounts of emergency care providers or family witnesses. Results: TCA at onset was described in 170 patients (11%). Patients with onset TCA were younger (P = 0.002), presented more often with poor clinical grade (55% vs. 26%, P<0.001) and had larger amounts of cisternal, intraventricular, and intracerebral blood than those without onset TCA (all, P<0.001). After adjusting for known confounders, onset TCA was significantly associated with in-hospital seizures (OR 3.80, 95%-CI: 2.43-5.96, P<0.001), in-hospital pneumonia (OR 1.56, 95%-CI: 1.06-2.31, p = 0.02), and delayed cerebral ischemia (OR 1.77, 95%-CI: 1.21-2.58, P = 0.003). At 3 months, however, onset TCA was not associated with poor functional outcome, mortality, and epilepsy after adjusting for age, admission clinical grade, and cisternal blood volume. Conclusions: Onset TCA is not a rare event as it complicates 11% of cases of SAH. New and clinically relevant findings are the association of onset TCA with in-hospital seizures, pneumonia and delayed cerebral ischemia. Despite the increased risk of in-hospital complications, onset TCA is not associated with disability, mortality, and epilepsy at 3 months.
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相关论文
共 23 条
[1]   SPONTANEOUS SUBARACHNOID HEMORRHAGE IN YOUNG-ADULTS [J].
BILLER, J ;
TOFFOL, GJ ;
KASSELL, NF ;
ADAMS, HP ;
BECK, DW ;
BOARINI, DJ .
NEUROSURGERY, 1987, 21 (05) :664-667
[2]   AMOUNT OF BLOOD ON COMPUTED-TOMOGRAPHY AS AN INDEPENDENT PREDICTOR AFTER ANEURYSM RUPTURE [J].
BROUWERS, PJAM ;
DIPPEL, DWJ ;
VERMEULEN, M ;
LINDSAY, KW ;
HASAN, D ;
VANGIJN, J .
STROKE, 1993, 24 (06) :809-814
[3]   Onset seizures independently predict poor outcome after subarachnoid hemorrhage [J].
Butzkueven, H ;
Evans, AH ;
Pitman, A ;
Leopold, C ;
Jolley, DJ ;
Kaye, AH ;
Kilpatrick, CJ ;
Davis, SM .
NEUROLOGY, 2000, 55 (09) :1315-1320
[4]   Seizures after aneurysmal subarachnoid hemorrhage treated with coil embolization [J].
Byrne, JV ;
Boardman, P ;
Ioannidis, I ;
Adcock, J ;
Traill, Z .
NEUROSURGERY, 2003, 52 (03) :545-550
[5]   Predictors and clinical impact of epilepsy after subarachnoid hemorrhage [J].
Claassen, J ;
Peery, S ;
Kreiter, KT ;
Hirsch, LJ ;
Du, EY ;
Connolly, ES ;
Mayer, SA .
NEUROLOGY, 2003, 60 (02) :208-214
[6]   Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage - The Fisher scale revisited [J].
Claassen, J ;
Bernardini, GL ;
Kreiter, K ;
Bates, J ;
Du, YLE ;
Copeland, D ;
Connolly, ES ;
Mayer, SA .
STROKE, 2001, 32 (09) :2012-2020
[7]  
de Rooij NK, 2012, STROKE, DOI [10.1161/STRO-KEAHA.112.674291, DOI 10.1161/STR0-KEAHA.112.674291]
[8]   Perioperative neurological complications after liver transplantation are best predicted by pre-transplant hepatic encephalopathy [J].
Dhar, Raiat ;
Young, G. Bryan ;
Marotta, Paul .
NEUROCRITICAL CARE, 2008, 8 (02) :253-258
[9]   Cortical spreading ischaemia is a novel process involved in ischaemic damage in patients with aneurysmal subarachnoid haemorrhage [J].
Dreier, Jens P. ;
Major, Sebastian ;
Manning, Andrew ;
Woitzik, Johannes ;
Drenckhahn, Chistoph ;
Steinbrink, Jens ;
Tolias, Christos ;
Oliveira-Ferreira, Ana I. ;
Fabricius, Martin ;
Hartings, Jed A. ;
Vajkoczy, Peter ;
Lauritzen, Martin ;
Dirnagl, Ulrich ;
Bohner, Georg ;
Strong, Anthony J. .
BRAIN, 2009, 132 :1866-1881
[10]   Defining Vasospasm After Subarachnoid Hemorrhage What Is the Most Clinically Relevant Definition? [J].
Frontera, Jennifer A. ;
Fernandez, Andres ;
Schmidt, J. Michael ;
Claassen, Jan ;
Wartenberg, Katja E. ;
Badjatia, Neeraj ;
Connolly, E. Sander ;
Mayer, Stephan A. .
STROKE, 2009, 40 (06) :1963-1968