Acute seizures after intracerebral hemorrhage: a factor in progressive midline shift and outcome.
OBJECTIVE
To determine whether early seizures that occur frequently after intracerebral hemorrhage (ICH) lead to increased brain edema as manifested by increased midline shift.


METHODS
A total of 109 patients with ischemic stroke (n = 46) and intraparenchymal hemorrhage (n = 63) prospectively underwent continuous EEG monitoring after admission. The incidence, timing, and factors associated with seizures were defined. Serial CT brain imaging was conducted at admission, 24 hours, and 48 to 72 hours after hemorrhage and assessed for hemorrhage volume and midline shift. Outcome at time of discharge was assessed using the Glasgow Outcome Scale score.


RESULTS
Electrographic seizures occurred in 18 of 63 (28%) patients with ICH, compared with 3 of 46 (6%) patients with ischemic stroke (OR = 5.7, 95% CI 1.4 to 26.5, p < 0.004) during the initial 72 hours after admission. Seizures were most often focal with secondary generalization. Seizures were more common in lobar hemorrhages but occurred in 21% of subcortical hemorrhages. Posthemorrhagic seizures were associated with neurologic worsening on the NIH Stroke Scale (14.8 vs 18.6, p < 0.05) and with an increase in midline shift (+ 2.7 mm vs -2.4 mm, p < 0.03). There was a trend toward increased poor outcome (p < 0.06) in patients with posthemorrhagic seizures. On multivariate analysis, age and initial NIH Stroke Scale score were independent predictors of outcome.


CONCLUSIONS
Seizures occur commonly after ICH and may be nonconvulsive. Seizures are independently associated with increased midline shift after intraparenchymal hemorrhage.
Division of Neurosurgery, Department of Neurology, UCLA Stroke Center, UCLA Brain Injury Research Center, University of California Los Angeles School of Medicine, CA 90095-7039, USA. Pvespa@mednet.ucla.edu
P M
PM
Vespa
K
K
O'Phelan
M
M
Shah
J
J
Mirabelli
S
S
Starkman
C
C
Kidwell
J
J
Saver
M R
MR
Nuwer
J G
JG
Frazee
D A
DA
McArthur
N A
NA
Martin
D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D001925:Brain Damage, Chronic / Q000209:etiology; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology*; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging; D018450:Disease Progression; D004569:Electroencephalography; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D012688:Septum Pellucidum / Q000000981:diagnostic imaging; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed
D000927:Anticonvulsants