Nonconvulsive status epilepticus in patients suffering spontaneous subarachnoid hemorrhage

Andrew S. Little, John F. Kerrigan, Cameron McDougall, Joseph M. Zabramski, Felipe C. Albuquerque, Peter Nakaji, Robert F. Spetzler

Research output: Contribution to journalArticle

Abstract

Object. Nonconvulsive status epilepticus (NCSE) is an underrecognized and poorly understood complication of aneurysmal subarachnoid hemorrhage (SAH). The authors evaluated the risk factors, electroencephalographic (EEG) characteristics, hospital course, and clinical outcomes associated with NCSE in a population with SAH treated at a single institution. Methods. The hospitalization and outcome data were reviewed in 11 patients who had received a diagnosis of NCSE and SAH. The study included individuals from a cohort of 389 consecutive patients with SAH who were treated between March 2003 and June 2005, and who were analyzed retrospectively. The patients' medical history, neurological grade, events of hospitalization, EEG morphological patterns, and disposition were analyzed. Advanced age, female sex, need for ventriculostomy, poor neurological grade (Hunt and Hess Grade III, IV, or V), thick cisternal blood clots, and structural lesions (intracerebral hemorrhage and stroke) were common in the population with NCSE. Patients with normal results on angiograms, good neurological grade (Hunt and Hess Grade I or II), and minimal SAH (Fisher Grade 1 or 2) were at lower risk. The most common ictal patterns were intermittent, and consisted of generalized periodic epileptiform discharges. Medical complications were also frequent, and the outcome of these patients was poor despite aggressive treatment regimens. Conclusions. Nonconvulsive status epilepticus is a devastating complication of SAH with a high rate of associated morbidity. Based on these findings it appears that the patients at highest risk for NCSE can be identified, and this should provide a basis for further studies designed to determine the clinical significance of various EEG patterns and to develop preventative strategies.

Original languageEnglish (US)
Pages (from-to)805-811
Number of pages7
JournalJournal of Neurosurgery
Volume106
Issue number5
DOIs
StatePublished - May 1 2007
Externally publishedYes

Fingerprint

Status Epilepticus
Subarachnoid Hemorrhage
Hospitalization
Stroke
Ventriculostomy
Cerebral Hemorrhage
Population
Angiography
Thrombosis
Morbidity

Keywords

  • Electroencephalography
  • Nonconvulsive status epilepticus
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Little, A. S., Kerrigan, J. F., McDougall, C., Zabramski, J. M., Albuquerque, F. C., Nakaji, P., & Spetzler, R. F. (2007). Nonconvulsive status epilepticus in patients suffering spontaneous subarachnoid hemorrhage. Journal of Neurosurgery, 106(5), 805-811. https://doi.org/10.3171/jns.2007.106.5.805

Nonconvulsive status epilepticus in patients suffering spontaneous subarachnoid hemorrhage. / Little, Andrew S.; Kerrigan, John F.; McDougall, Cameron; Zabramski, Joseph M.; Albuquerque, Felipe C.; Nakaji, Peter; Spetzler, Robert F.

In: Journal of Neurosurgery, Vol. 106, No. 5, 01.05.2007, p. 805-811.

Research output: Contribution to journalArticle

Little, AS, Kerrigan, JF, McDougall, C, Zabramski, JM, Albuquerque, FC, Nakaji, P & Spetzler, RF 2007, 'Nonconvulsive status epilepticus in patients suffering spontaneous subarachnoid hemorrhage', Journal of Neurosurgery, vol. 106, no. 5, pp. 805-811. https://doi.org/10.3171/jns.2007.106.5.805
Little, Andrew S. ; Kerrigan, John F. ; McDougall, Cameron ; Zabramski, Joseph M. ; Albuquerque, Felipe C. ; Nakaji, Peter ; Spetzler, Robert F. / Nonconvulsive status epilepticus in patients suffering spontaneous subarachnoid hemorrhage. In: Journal of Neurosurgery. 2007 ; Vol. 106, No. 5. pp. 805-811.
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abstract = "Object. Nonconvulsive status epilepticus (NCSE) is an underrecognized and poorly understood complication of aneurysmal subarachnoid hemorrhage (SAH). The authors evaluated the risk factors, electroencephalographic (EEG) characteristics, hospital course, and clinical outcomes associated with NCSE in a population with SAH treated at a single institution. Methods. The hospitalization and outcome data were reviewed in 11 patients who had received a diagnosis of NCSE and SAH. The study included individuals from a cohort of 389 consecutive patients with SAH who were treated between March 2003 and June 2005, and who were analyzed retrospectively. The patients' medical history, neurological grade, events of hospitalization, EEG morphological patterns, and disposition were analyzed. Advanced age, female sex, need for ventriculostomy, poor neurological grade (Hunt and Hess Grade III, IV, or V), thick cisternal blood clots, and structural lesions (intracerebral hemorrhage and stroke) were common in the population with NCSE. Patients with normal results on angiograms, good neurological grade (Hunt and Hess Grade I or II), and minimal SAH (Fisher Grade 1 or 2) were at lower risk. The most common ictal patterns were intermittent, and consisted of generalized periodic epileptiform discharges. Medical complications were also frequent, and the outcome of these patients was poor despite aggressive treatment regimens. Conclusions. Nonconvulsive status epilepticus is a devastating complication of SAH with a high rate of associated morbidity. Based on these findings it appears that the patients at highest risk for NCSE can be identified, and this should provide a basis for further studies designed to determine the clinical significance of various EEG patterns and to develop preventative strategies.",
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AU - Spetzler, Robert F.

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