Journal Article

Seizures at the onset of aneurysmal SAH: epiphenomenon or valuable predictor?

Dinger, Thiemo F, Rauschenbach Laurèl, Jabbarli Ramazan, Darkwah Oppong Marvin, Chihi Mehdi, Bastias, Marcela Jara, Wrede, Karsten H, Pierscianek Daniela, Droste Leonie, Dammann Philipp, sting, Michael, Quesada, Carlos, Ahmadipour Yahya, Sure Ulrich

2021

Overview

ObjectiveSeizures at the onset (SAO) of aneurysmal subarachnoid hemorrhage (aSAH) occur in up to one of every five cases. To date, there is no consensus on causal background and clinical value of these early bleeding-related seizures. This study aimed to analyze the predictors and the impact of SAO in aSAH.MethodsAll aSAH patients from the institutional observational cohort (01/2003–06/2016) were retrospectively reviewed. Patients’ charts and emergency protocols from first responders were screened for the occurrence of seizures in the first 24 h after aSAH. Patients’ baseline characteristics and occurrence of post-hemorrhagic complications were analyzed. Outcome endpoints included in-hospital mortality and poor outcome at 6-month follow-up (modified Rankin Scale > 3).ResultsOf 984 patients included in the final analysis, SAO occurred in 93 cases (9.5%) and were independently associated with younger age (< 51 years, p < 0.001), WFNS grade ≥ 4 (p < 0.001), aneurysm characteristics (location at the proximal branch of the anterior cerebral artery [p = 0.037] and irregular sac [p = 0.019]) and admission body temperature > 38.3 ℃ (p = 0.008). There was an association between SAO and early complications (early infarcts [p = 0.004] and primary decompressive craniectomy [p = 0.024]). Only in the subgroup analysis restricted to the younger individuals, SAO independently predicted poor outcome of aSAH (p = 0.002).SignificanceOnset seizures following aSAH are rare and most likely related to the severity of early brain injury. Particularly, younger individuals are not only at higher risk for SAO, but are also prone to poor outcome in case of aSAH accompanied with SAO.Trial registration numberGerman clinical trial registry (DRKS, unique identifier: DRKS00008749, 06/09/2015)

• Publisher: Springer Nature B.V
• Subject: Aneurysm / Aneurysms / Body temperature / Brain injury / Clinical trials / Consciousness / Convulsions & seizures / First responders / Hemorrhage / Hydrocephalus / Laboratories / Neurology / Neurosurgery / Patients / Seizures / Skull / Statistical analysis / Subarachnoid hemorrhage / Traumatic brain injury / Veins & arteries