Faculty Bibliography

OBJECTIVE: To determine the frequency and significance of electrographic seizures and other EEG findings in patients with intracerebral hemorrhage (ICH). METHODS: We reviewed 102 consecutive patients with ICH who underwent continuous electroencephalographic monitoring (cEEG). Demographic, clinical, radiographic, and cEEG findings were recorded. Using multivariate logistic regression analysis, we determined factors associated with 1) electrographic seizures, 2) periodic epileptiform discharges (PEDs), and 3) poor outcome (death, vegetative or minimally conscious state) at hospital discharge. RESULTS: Seizures occurred in 31% (n = 32) of patients with ICH, prior to cEEG in 19 patients. Eighteen percent (n = 18) of patients had electrographic seizures; only one of these patients also had clinical seizures while on cEEG. After controlling for demographic and clinical predictors, only an increase in ICH volume of 30% or more between admission and 24-hour follow-up CT scan was associated with electrographic seizures (33% vs 15%; OR 9.5, 95% CI 1.7 to 53.8). PEDs were less frequently seen in those with hemorrhages located at least 1 mm from the cortex (8% vs 29%; OR 0.2, 95% CI 0.1 to 0.7). PEDs were independently associated with poor outcome (65% vs 17%; OR 7.6, 95% CI 2.1 to 27.3). In patients with electrographic seizures, the first seizure was detected within the first hour of cEEG monitoring in 56% and within 48 hours in 94%. CONCLUSIONS: Seizures occurred in one third of patients with intracerebral hemorrhage (ICH) and over half were purely electrographic. Electrographic seizures were associated with expanding hemorrhages, and periodic discharges with cortical ICH and poor outcome. Further research is needed to determine if treating or preventing seizures or PEDs might lead to improved outcome after ICH.

INTRODUCTION: Cerebral arterial vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is an important cause of delayed neurologic deterioration. Vasospasm following isolated intraventricular hemorrhage (IVH) is less common. Accepted predictors of vasospasm following SAH include poor Hunt-Hess grade, elevated transcranial Doppler velocities, and the thickness of cisternal blood on neuroimaging [1, 2]. The role of intraventricular hemorrhage in vasospasm is more controversial. METHODS: Case report and review of the literature. RESULTS: A 41-year-old woman developed symptomatic delayed vasospasm 10 days following isolated IVH due to the rupture of an arteriovenous malformation (AVM). CONCLUSION: Intraventricular hemorrhage can independently cause significant delayed vasospasm. Possible mechanisms are described.