Abstract Details

Title Subarachnoid Extension of Hemorrhage Is Associated with Seizures in Primary Intracerebral Hemorrhage

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) S07 - (-)

Poster/Presentation
Number 005

Background Extension of hemorrhage into the subarachnoid space in primary ICH has recently been associated with poor outcomes, although the mechanisms underlying that association are uncertain.

Objective

Design/Methods Patients with primary ICH were enrolled into a prospective registry between December 2006 and July 2012. Patients were managed, and serial neuroimaging obtained, per a structured protocol. SAHE was identified on imaging, along with ICH volumes, 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. A binary logistic regression models was developed to test whether the occurrence of SAHE was a predictor of seizures, independent of ICH Score.

Results 234 patients were studied, and 93 (39.7%) had SAHE. SAHE was associated with lobar hemorrhage location (65% of SAHE versus 19% of non-SAHE cases, p<0.001), and larger hematoma volumes (median 23.8 versus 6.65, p<0.001). SAHE was a predictor of seizures (odds ratio 4.12 [95% CI 1.01-16.72], p=0.048) after adjustment for ICH Score.

Conclusions SAHE is associated with seizures in patients with primary ICH. SAHE appears to provoke cortical irritability and dysfunction, which may contribute to the association between SAHE and poor functional outcomes. A high index of suspicion for seizures is appropriate in ICH patients with SAHE.

Authors/Disclosures
James Guth, MD PRESENTER	No disclosure on file
	No disclosure on file
Eric Liotta, MD (Northwestern University)	Dr. Liotta has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Penumbra. The institution of Dr. Liotta has received research support from NIH-NINDS.
	No disclosure on file
	No disclosure on file
Matthew Sidovar (Acorda Therapeutics)	No disclosure on file
Neil Rosenberg, MD (Rosenberg Medical, PLLC)	Dr. Rosenberg has nothing to disclose.
Shyam Prabhakaran, MD (University of Chicago)	Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. The institution of Dr. Prabhakaran has received research support from NIH . The institution of Dr. Prabhakaran has received research support from AHRQ. Dr. Prabhakaran has received publishing royalties from a publication relating to health care.
Andrew M. Naidech, MD, FAAN (Department of Neurology)	The institution of Dr. Naidech has received research support from NIH. Dr. Naidech has received publishing royalties from a publication relating to health care.
Francisco Rocha	Francisco Rocha has received personal compensation for serving as an employee of BIAL - Portela.
Matthew Maas, MD, FAAN (Northwestern University)	The institution of Dr. Maas has received research support from National Institutes of Health.

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