Seizures and organ dysfunction after subarachnoid hemorrhage

Introduction

Nonconvulsive status epilepticus (NCSE), non-convulsive seizures (NCSZ) and periodic epileptiform discharges (PEDs) are common and associated with poor outcome after subarachnoid hemorrhage (SAH). The objective of this study is to describe the frequency of renal, liver, thrombotic and metabolic dysfunction after SAH and their association with NCSE, NCSZ and PEDs.

Methods

We studied all patients with SAH who underwent cEEG monitoring from 1997 to 2004. Data assessed included admission creatinine, maximum values during the first 14 days for creatinine and total bilirubin, and minimum bicarbonate, base excess and platelets. Renal failure was defined either as a maximum creatinine >1.1 mg/dl or as an increase in creatinine >50% from baseline. Severity of renal dysfunction was assessed by the RIFLE criteria. The other continuous variables were dichotomized using the mean value as the cutoff point that defined liver dysfunction, metabolic acidosis and thrombocytopenia. Univariate logistic regression was conducted to identify associations between predictor variables with NCSE, NCSZ and PEDs. Significant (P < 0.25) and clinically meaningful variables were then included in a multivariable logistic regression model to identify independent associations.

Results

A total of 116 patients were studied. The mean age was 58 ± 16 years and 80 (69%) were female. Eighty-eight percent of the patients had a Hunt–Hess grade at admission of 3 or worse. Twelve patients (10%) developed NCSE, 17 (15%) NCSZ and 26 (22%) PEDs. Acute renal failure (ARF) developed in 18 (15%) patients, liver dysfunction in 24 (21%), low bicarbonate in 37 (32%), low base excess in 72 (62%) and thrombocytopenia in 55 (47%). After adjusting for age, gender and Hunt–Hess grade, patients with severe metabolic acidosis were six times more likely to develop NCSZ as compared with those without acidosis (OR = 5.9, 95% CI = 1.2 to 27.8, P = 0.03). Similarly, after adjusting for age, gender and Hunt–Hess grade, patients with renal dysfunction were six times more likely to develop NCSE as compared with those without ARF (OR = 5.8, 95% CI = 1.5 to 21.8, P = 0.01). No association was found with PEDs.

Conclusion

Organ dysfunction is common after SAH. Metabolic acidosis and renal dysfunction were independently associated with the development of NCSZ and NCSE, respectively.