Seizures at the onset of aneurysmal SAH: epiphenomenon or valuable predictor?
- PDF / 914,819 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 38 Downloads / 137 Views
ORIGINAL COMMUNICATION
Seizures at the onset of aneurysmal SAH: epiphenomenon or valuable predictor? Marvin Darkwah Oppong1 · Marcela Jara Bastias1 · Daniela Pierscianek1 · Leonie Droste1 · Thiemo F. Dinger1 · Yahya Ahmadipour1 · Laurèl Rauschenbach1 · Carlos Quesada2 · Mehdi Chihi1 · Philipp Dammann1 · Michael Forsting3 · Karsten H. Wrede1 · Ulrich Sure1 · Ramazan Jabbarli1 Received: 15 July 2020 / Revised: 12 August 2020 / Accepted: 17 August 2020 © The Author(s) 2020
Abstract Objective Seizures 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. Methods All 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). Results Of 984 patients included in the final analysis, SAO occurred in 93 cases (9.5%) and were independently associated with younger age ( 38.3 ℃]) and during the whole hospital stay (ICP elevation > 20 mmHg requiring conservative/surgical treatment, total time of mechanical ventilation [in days], occurrence of aneurysm rebleeding and DIND) were extracted from the daily intensive care charts. DIND was defined as clinical deterioration of more than 2 points on the Glasgow coma scale or new neurological deficit without any other explanation [11]. The following laboratory values at admission were also recorded for further analysis: increased C-reactive protein (CRP, > 0.5 mg/dL), leukocytosis (white blood cell count [WBC] > 10/nL), hypo- and hypernatremia (serum sodium level 145 mmol/L, respectively), hypo- and hypercalcaemia (serum calcium level 2.7 mmol/L, respectively). Finally, in-hospital mortality and poor outcome, defined as a modified Rankin scale (mRS) score > 3 at 6-month follow-up, were used as outcome endpoints.
Statistical analysis We used SPSS 22 for Windows (IBM Corp.) and PRISM v. 5.0 (GraphPad Software) for all statistical analyses. Significance level was set to p 0.5 mg/dl Hypernatremia Hyponatremia Hypercalcemia
dACA distal anterior cerebral artery, IA intracranial aneurysm, ICA internal carotic artery, ICH intracerebral hemorrhage, IVH intraventricular hemorrhage, MCA middle cerebral artery, pACA proximal anterior cerebral artery, p/sDC primary/secondary decompressive craniectomy *Data missing for 78 patients †
Data missing for nine patients
‡
48 patients received no treatment
§
Data missing for 12 patients
aSAH characteristics and SAO Patients in the SAO group were more likely to present with WFNS = 4–5 (OR = 2.67, 95% CI 1.
Data Loading...
