Article
Seizures at the onset of aneurysmal subarachnoid haemorrhage – risk factors and clinical impact
Krampfanfälle beim Blutungsereignis bei aneurysmatischen Subarachnoidalblutungen – Risikofaktoren und klinischer Einfluss
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Published: | June 26, 2020 |
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Objective: Alongside with typical clinical symptoms like headache and impairment of consciousness, rupture of intracranial aneurysms might also cause seizures at the onset (SAO). There are conflicting reports on the causes and clinical value of SAO after aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to analyze the incidence, predictors of and the impact of SAO in s large aSAH cohort.
Methods: All aSAH patients treated at a single center during the observational period between 01/2003 and 06/2016, were retrospectively reviewed. Patient charts and emergency protocols from first responders were screened for occurrence of SAO. Baseline demographic and clinical characteristics were also extracted from the digital patients’ charts. Radiographic imaging was reviewed for the initial severity and occurrence of delayed complications. Patients with known epilepsy before aSAH were excluded before further analysis. Outcome parameters included in hospital mortality and unfavorable outcome at six-month follow-up (mRS > 3). Univariate and multivariate analysis were performed.
Results: A total of 948 patients were included in the final analysis. aSAH patients with SAO (n=90, 9.5%) were younger (48 ± 13 vs. 55 ± 14 years; p<0.001), had higher radiographic severity (Fisher Grades=3-4, p=0.007, OR=3.76) and presented more commonly with intraventricular (p<0.001,OR=2.43) as well as intraparencymal hemorrhage (p=0.012;OR=1.76). In multivariate analysis, SAO was associated (p<0.001; aOR=2.53) with poor initial clinical condition (WFNS Grade 4-5) independently of age (>50 years, p=0.019; aOR=1.42) and radiographic severity (p<0.001; aOR=24.04). In the whole cohort, SAO was not associated with in-hospital mortality (p=0.514) and functional outcome at six months (p=0.118). At the same time, multivariate analysis within the WFNS Grade 4-5 patients showed independent association between the SAO and lower risk of in-hospital mortality (p=0.038; aOR=0.43).
Conclusion: Younger individuals with severe aSAH, especially accompanied by blood distribution outside of the subarachnoid space, are at higher risk of SAO and, therefore, poorer initial clinical presentation. Due to inverse association between the mortality risk and SAO in WFNS Grade=4-5 aSAH patients, the occurrence of SAO in these patients might necessitate reconsidering their clinical grading and appropriate treatment decisions.