Nonconvulsive status epilepticus in patients suffering spontaneous subarachnoid hemorrhage.
OBJECTIVE
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.
Little
Andrew S
AS
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Kerrigan
John F
JF
McDougall
Cameron G
CG
Zabramski
Joseph M
JM
Albuquerque
Felipe C
FC
Nakaji
Peter
P
Spetzler
Robert F
RF
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D004359:Drug Therapy, Combination; D004569:Electroencephalography / Q000187:drug effects; D004621:Embolization, Therapeutic; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000187:drug effects; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D013226:Status Epilepticus / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome; D014696:Ventriculostomy
D000927:Anticonvulsants