title: Subarachnoid extension of hemorrhage is associated with early seizures in primary intracerebral hemorrhage.
abstract: BACKGROUND
  Seizures are common in patients with subarachnoid hemorrhage, potentially by inciting cortical irritability. Seizures are also commonly seen after intracerebral hemorrhage (ICH), although the mechanisms and risk factors within that population are not well understood. The objective of this study is to evaluate whether subarachnoid hemorrhage extension (SAHE) is associated with early seizures in patients with primary ICH.
  
  
  METHODS
  Patients with primary ICH were enrolled into a prospective registry between December 2006 and July 2012. Patients were managed per a structured protocol. SAHE was identified on imaging by expert reviewers blinded to outcomes. Electroencephalograms were routinely obtained in patients with unexplained, poor level of arousal. Seizure was determined by clinically observed convulsions or traditional electroencephalographic criteria. Early seizures were defined as occurring within 3 days of hemorrhage. A binary logistic regression model was developed to test whether the occurrence of SAHE was independently associated with seizures.
  
  
  RESULTS
  A total of 234 patients were studied. Of these, 93 (40%) had SAHE and 9 (4%) had early seizures. SAHE was associated with early seizures (P = .03). No additional variables were identified by regression modeling to mediate the association between SAHE and early seizures (odds ratio 5.62 [95% confidence interval 1.14-27.7], P = .034).
  
  
  CONCLUSIONS
  SAHE is associated with early seizures in patients with primary ICH. Further study is needed to confirm these findings and determine whether modifications to routine care based on the presence of SAHE would be of benefit.
authors.affiliation: Division of Vascular and Critical Care Neurology, Department of Neurology, Northwestern University, Chicago, IL. Electronic address: james.guth@northwestern.edu.
authors.forename: James C
authors.initials: JC
authors.lastname: Guth
authors.affiliation: Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Northwestern University, Chicago, IL.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Gerard
authors.affiliation: Division of Neuroradiology, Department of Radiology, Northwestern University, Chicago, IL.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Nemeth
authors.affiliation: Division of Vascular and Critical Care Neurology, Department of Neurology, Northwestern University, Chicago, IL.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Liotta
authors.affiliation: Division of Vascular and Critical Care Neurology, Department of Neurology, Northwestern University, Chicago, IL.
authors.forename: Shyam
authors.initials: S
authors.lastname: Prabhakaran
authors.affiliation: Division of Vascular and Critical Care Neurology, Department of Neurology, Northwestern University, Chicago, IL.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Naidech
authors.affiliation: Division of Vascular and Critical Care Neurology, Department of Neurology, Northwestern University, Chicago, IL.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Maas
mesh_terms: D000368:Aged; D058256:Brain Waves; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000175:diagnosis; D018450:Disease Progression; D004569:Electroencephalography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D013997:Time Factors
keywords: Intracerebral hemorrhage; critical care; neurocritical care; seizures; subarachnoid extension