Epileptic seizures after subarachnoid hemorrhage

Abstract

We srudied predictive factors for the occurrence of epilepsy in 381 consecutive patients admitted within 72 hours after they had a subarachnoid hemorrhage from a reprued itracranial aneursym. Fits occurring in the presence of byponattremia or within 12 hours after the initial bleed, rebleeding, or aneurysm surgery were classifed as associated with these acute events and we did not regard these fits subsequent epileptic seizures. Thirty-five patients (9%) had one or more epileptic seizures, 12 hours to 1,761 days after the initial bleed (median value, 18 days). The following variables were included in the analysis: sex age, history of hypertension, historyof cardiovascular disease, loss of consciousness at ictus, sum score on the Glasgow Coma Scale on admission, sum score for the amount of cisternal blood and and presence of intraventricular blood based on the initial computed tomography(CT) scan, occurrence of ictal seizures (seizures occurring within 12 hours after the onset), acute hydrocephalus, rebleeding, delayed cerebral ischemia, fluid intake, treatment with tranexamic acid, ventricular drainage, and aneurysm surgery. After multivariate analysis by means of Cox proportional hazards model with stepwise forward selection of the variables, a high cisternal blood score and rebleeding proved to be significantly related to epilepsy (hazard ratio = 2.06, p = 0.040; and hazard ration = 3.02 p = 0016), even after the exclusion of 28 patients who receive perioperative prophylactic anticonvulsant therapy (hazard ratio = 2.31, P = 0.022; and hazard ratio =3.65, p = 0.006, respectively). We conclude that the frequency of epilepsy after the occurrence of subarachnoid hemorrhage is substantial and that except for rebleeding and a high cisternal blood score on the intitial CT scan, none of the investigated variables, including the occurrence of epieptic seizures within the first 12 hours following the intial bleed, are related to epilepsy.