High Risk for Seizures Following Subarachnoid Hemorrhage Regardless of Referral Bias

被引:33
作者
O'Connor, Kathryn L. [1 ]
Westover, M. Brandon [1 ]
Phillips, Michael T. [2 ]
Iftimia, Nicolae A. [1 ]
Buckley, Deidre A. [3 ]
Ogilvy, Christopher S. [3 ]
Shafi, Mouhsin M. [1 ,4 ]
Rosenthal, Eric S. [1 ]
机构
[1] Massachusetts Gen Hosp, Dept Neurol, Boston, MA 02114 USA
[2] Massachusetts Gen Hosp, Dept Neurosurg, Boston, MA 02114 USA
[3] Beth Israel Deaconess Med Ctr, Dept Neurosurg, Boston, MA 02215 USA
[4] Beth Israel Deaconess Med Ctr, Dept Neurol, Boston, MA 02215 USA
关键词
Subarachnoid hemorrhage; Non-convulsive seizures; Continuous electroencephalography; CRITICALLY-ILL; CONTINUOUS EEG; EPILEPSY; COILING;
D O I
10.1007/s12028-014-9974-y
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
To investigate the frequency, predictors, and clinical impact of electrographic seizures in patients with high clinical or radiologic grade non-traumatic subarachnoid hemorrhage (SAH), independent of referral bias. We compared rates of electrographic seizures and associated clinical variables and outcomes in patients with high clinical or radiologic grade non-traumatic SAH. Rates of electrographic seizure detection before and after institution of a guideline which made continuous EEG monitoring routine in this population were compared. Electrographic seizures occurred in 17.6 % of patients monitored expressly because of clinically suspected subclinical seizures. In unselected patients, seizures still occurred in 9.6 % of all cases, and in 8.6 % of cases in which there was no a priori suspicion of seizures. The first seizure detected occurred 5.4 (IQR 2.9-7.3) days after onset of subarachnoid hemorrhage with three of eight patients (37.5 %) having the first recorded seizure more than 48 h following EEG initiation, and 2/8 (25 %) at more than 72 h following EEG initiation. High clinical grade was associated with poor outcome at time of hospital discharge; electrographic seizures were not associated with poor outcome. Electrographic seizures occur at a relatively high rate in patients with non-traumatic SAH even after accounting for referral bias. The prolonged time to the first detected seizure in this cohort may reflect dynamic clinical features unique to the SAH population.
引用
收藏
页码:476 / 482
页数:7
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