Acute seizures after intracerebral hemorrhage

A factor in progressive midline shift and outcome

Paul M. Vespa, Kristine H O'Phelan, M. Shah, J. Mirabelli, S. Starkman, C. Kidwell, J. Saver, M. R. Nuwer, J. G. Frazee, D. A. McArthur, N. A. Martin

Research output: Contribution to journalArticle

382 Citations (Scopus)

Abstract

Objective: To determine whether early seizures that occur frequently after intracerebral hemorrhage (ICH) lead to increased brain edema as manifested by increased midline shift. Methods: A total of 109 patients with ischemic stroke (n = 46) and intraparenchymal hemorrhage (n = 63) prospectively underwent continuous EEG monitoring after admission. The incidence, timing, and factors associated with seizures were defined. Serial CT brain imaging was conducted at admission, 24 hours, and 48 to 72 hours after hemorrhage and assessed for hemorrhage volume and midline shift. Outcome at time of discharge was assessed using the Glasgow Outcome Scale score. Results: Electrographic seizures occurred in 18 of 63 (28%) patients with ICH, compared with 3 of 46 (6%) patients with ischemic stroke (OR = 5.7, 95% CI 1.4 to 26.5, p < 0.004) during the initial 72 hours after admission. Seizures were most often focal with secondary generalization. Seizures were more common in lobar hemorrhages but occurred in 21% of subcortical hemorrhages. Posthemorrhagic seizures were associated with neurologic worsening on the NIH Stroke Scale (14.8 vs 18.6, p < 0.05) and with an increase in midline shift (+2.7 mm vs -2.4 mm, p < 0.03). There was a trend toward increased poor outcome (p < 0.06) in patients with posthemorrhagic seizures. On multivariate analysis, age and initial NIH Stroke Scale score were independent predictors of outcome. Conclusion: Seizures occur commonly after ICH and may be nonconvulsive. Seizures are independently associated with increased midline shift after intraparenchymal hemorrhage.

Original languageEnglish
Pages (from-to)1441-1446
Number of pages6
JournalNeurology
Volume60
Issue number9
StatePublished - May 13 2003
Externally publishedYes

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Cerebral Hemorrhage
Seizures
Hemorrhage
Stroke
Glasgow Outcome Scale
Brain Edema
Neuroimaging
Nervous System
Electroencephalography
Multivariate Analysis
Incidence

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Vespa, P. M., O'Phelan, K. H., Shah, M., Mirabelli, J., Starkman, S., Kidwell, C., ... Martin, N. A. (2003). Acute seizures after intracerebral hemorrhage: A factor in progressive midline shift and outcome. Neurology, 60(9), 1441-1446.

Acute seizures after intracerebral hemorrhage : A factor in progressive midline shift and outcome. / Vespa, Paul M.; O'Phelan, Kristine H; Shah, M.; Mirabelli, J.; Starkman, S.; Kidwell, C.; Saver, J.; Nuwer, M. R.; Frazee, J. G.; McArthur, D. A.; Martin, N. A.

In: Neurology, Vol. 60, No. 9, 13.05.2003, p. 1441-1446.

Research output: Contribution to journalArticle

Vespa, PM, O'Phelan, KH, Shah, M, Mirabelli, J, Starkman, S, Kidwell, C, Saver, J, Nuwer, MR, Frazee, JG, McArthur, DA & Martin, NA 2003, 'Acute seizures after intracerebral hemorrhage: A factor in progressive midline shift and outcome', Neurology, vol. 60, no. 9, pp. 1441-1446.
Vespa PM, O'Phelan KH, Shah M, Mirabelli J, Starkman S, Kidwell C et al. Acute seizures after intracerebral hemorrhage: A factor in progressive midline shift and outcome. Neurology. 2003 May 13;60(9):1441-1446.
Vespa, Paul M. ; O'Phelan, Kristine H ; Shah, M. ; Mirabelli, J. ; Starkman, S. ; Kidwell, C. ; Saver, J. ; Nuwer, M. R. ; Frazee, J. G. ; McArthur, D. A. ; Martin, N. A. / Acute seizures after intracerebral hemorrhage : A factor in progressive midline shift and outcome. In: Neurology. 2003 ; Vol. 60, No. 9. pp. 1441-1446.
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abstract = "Objective: To determine whether early seizures that occur frequently after intracerebral hemorrhage (ICH) lead to increased brain edema as manifested by increased midline shift. Methods: A total of 109 patients with ischemic stroke (n = 46) and intraparenchymal hemorrhage (n = 63) prospectively underwent continuous EEG monitoring after admission. The incidence, timing, and factors associated with seizures were defined. Serial CT brain imaging was conducted at admission, 24 hours, and 48 to 72 hours after hemorrhage and assessed for hemorrhage volume and midline shift. Outcome at time of discharge was assessed using the Glasgow Outcome Scale score. Results: Electrographic seizures occurred in 18 of 63 (28{\%}) patients with ICH, compared with 3 of 46 (6{\%}) patients with ischemic stroke (OR = 5.7, 95{\%} CI 1.4 to 26.5, p < 0.004) during the initial 72 hours after admission. Seizures were most often focal with secondary generalization. Seizures were more common in lobar hemorrhages but occurred in 21{\%} of subcortical hemorrhages. Posthemorrhagic seizures were associated with neurologic worsening on the NIH Stroke Scale (14.8 vs 18.6, p < 0.05) and with an increase in midline shift (+2.7 mm vs -2.4 mm, p < 0.03). There was a trend toward increased poor outcome (p < 0.06) in patients with posthemorrhagic seizures. On multivariate analysis, age and initial NIH Stroke Scale score were independent predictors of outcome. Conclusion: Seizures occur commonly after ICH and may be nonconvulsive. Seizures are independently associated with increased midline shift after intraparenchymal hemorrhage.",
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AU - Vespa, Paul M.

AU - O'Phelan, Kristine H

AU - Shah, M.

AU - Mirabelli, J.

AU - Starkman, S.

AU - Kidwell, C.

AU - Saver, J.

AU - Nuwer, M. R.

AU - Frazee, J. G.

AU - McArthur, D. A.

AU - Martin, N. A.

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N2 - Objective: To determine whether early seizures that occur frequently after intracerebral hemorrhage (ICH) lead to increased brain edema as manifested by increased midline shift. Methods: A total of 109 patients with ischemic stroke (n = 46) and intraparenchymal hemorrhage (n = 63) prospectively underwent continuous EEG monitoring after admission. The incidence, timing, and factors associated with seizures were defined. Serial CT brain imaging was conducted at admission, 24 hours, and 48 to 72 hours after hemorrhage and assessed for hemorrhage volume and midline shift. Outcome at time of discharge was assessed using the Glasgow Outcome Scale score. Results: Electrographic seizures occurred in 18 of 63 (28%) patients with ICH, compared with 3 of 46 (6%) patients with ischemic stroke (OR = 5.7, 95% CI 1.4 to 26.5, p < 0.004) during the initial 72 hours after admission. Seizures were most often focal with secondary generalization. Seizures were more common in lobar hemorrhages but occurred in 21% of subcortical hemorrhages. Posthemorrhagic seizures were associated with neurologic worsening on the NIH Stroke Scale (14.8 vs 18.6, p < 0.05) and with an increase in midline shift (+2.7 mm vs -2.4 mm, p < 0.03). There was a trend toward increased poor outcome (p < 0.06) in patients with posthemorrhagic seizures. On multivariate analysis, age and initial NIH Stroke Scale score were independent predictors of outcome. Conclusion: Seizures occur commonly after ICH and may be nonconvulsive. Seizures are independently associated with increased midline shift after intraparenchymal hemorrhage.

AB - Objective: To determine whether early seizures that occur frequently after intracerebral hemorrhage (ICH) lead to increased brain edema as manifested by increased midline shift. Methods: A total of 109 patients with ischemic stroke (n = 46) and intraparenchymal hemorrhage (n = 63) prospectively underwent continuous EEG monitoring after admission. The incidence, timing, and factors associated with seizures were defined. Serial CT brain imaging was conducted at admission, 24 hours, and 48 to 72 hours after hemorrhage and assessed for hemorrhage volume and midline shift. Outcome at time of discharge was assessed using the Glasgow Outcome Scale score. Results: Electrographic seizures occurred in 18 of 63 (28%) patients with ICH, compared with 3 of 46 (6%) patients with ischemic stroke (OR = 5.7, 95% CI 1.4 to 26.5, p < 0.004) during the initial 72 hours after admission. Seizures were most often focal with secondary generalization. Seizures were more common in lobar hemorrhages but occurred in 21% of subcortical hemorrhages. Posthemorrhagic seizures were associated with neurologic worsening on the NIH Stroke Scale (14.8 vs 18.6, p < 0.05) and with an increase in midline shift (+2.7 mm vs -2.4 mm, p < 0.03). There was a trend toward increased poor outcome (p < 0.06) in patients with posthemorrhagic seizures. On multivariate analysis, age and initial NIH Stroke Scale score were independent predictors of outcome. Conclusion: Seizures occur commonly after ICH and may be nonconvulsive. Seizures are independently associated with increased midline shift after intraparenchymal hemorrhage.

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