Journal Article

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

Agarwal, Sachin, Schmidt, J. Michael, Claassen, Jan, Mayer, Stephan A., Lantigua, Hector, Pugin, Deborah, Zammit, Christopher, De Marchis, Gian Marco, Tadi, Prasanna, Falo, M. Cristina

2013

Overview

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. 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. 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. 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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Aneurysms / Blood / Blood volume / Brain Ischemia - etiology / Complications / Consciousness / Critical care / Emergency medical care / Emergency medical services / Emergency medicine / Epilepsy / Epilepsy, Tonic-Clonic - etiology / Female / Health care facilities / Hemorrhage / Hospitalization / Hospitals / Humans / Interviews / Ischemia / Male / Medical centers / Medical imaging / Medical research / Medicine / Middle Aged / Mortality / Neurology / Neurosurgery / Patient Outcome Assessment / Patient outcomes / Patients / Physicians / Pneumonia / Pneumonia - etiology / Seizing / Seizures / Seizures (Medicine) / Stroke / Subarachnoid hemorrhage / Subarachnoid Hemorrhage - complications / Surgeons / Systemic Inflammatory Response Syndrome - etiology