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 language | English (US) |
|---|---|
| Pages (from-to) | 805-811 |
| Number of pages | 7 |
| Journal | Journal of Neurosurgery |
| Volume | 106 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 1 2007 |
| Externally published | Yes |
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Keywords
- Electroencephalography
- Nonconvulsive status epilepticus
- Subarachnoid hemorrhage
ASJC Scopus subject areas
- Surgery
- Clinical Neurology
Cite this
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 journal › Article
}
TY - JOUR
T1 - Nonconvulsive status epilepticus in patients suffering spontaneous subarachnoid hemorrhage
AU - Little, Andrew S.
AU - Kerrigan, John F.
AU - McDougall, Cameron
AU - Zabramski, Joseph M.
AU - Albuquerque, Felipe C.
AU - Nakaji, Peter
AU - Spetzler, Robert F.
PY - 2007/5/1
Y1 - 2007/5/1
N2 - 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.
AB - 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.
KW - Electroencephalography
KW - Nonconvulsive status epilepticus
KW - Subarachnoid hemorrhage
UR - http://www.scopus.com/inward/record.url?scp=34247863838&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34247863838&partnerID=8YFLogxK
U2 - 10.3171/jns.2007.106.5.805
DO - 10.3171/jns.2007.106.5.805
M3 - Article
C2 - 17542523
AN - SCOPUS:34247863838
VL - 106
SP - 805
EP - 811
JO - Journal of Neurosurgery
JF - Journal of Neurosurgery
SN - 0022-3085
IS - 5
ER -