Seizures associated with spontaneous subarachnoid hemorrhage

Area of Science:

• Neurology
• Neurosurgery
• Critical Care Medicine

Background:

• Subarachnoid hemorrhage (SAH) is a critical neurological event.
• Seizures are a known complication of SAH.
• The role of prophylactic anticonvulsants in SAH is debated.

Purpose of the Study:

• To investigate the incidence and characteristics of seizures in spontaneous subarachnoid hemorrhage (SAH) patients without arteriovenous malformations.
• To evaluate the impact of early seizures on patient outcomes.
• To assess the necessity of long-term prophylactic anticonvulsants.

Main Methods:

• Retrospective analysis of 131 consecutive spontaneous subarachnoid hemorrhage cases.
• Exclusion of patients with arteriovenous malformations.
• Chart review for seizure occurrence, timing, and clinical manifestations.
• Comparison of outcomes (mortality, rebleeding, hematoma) between seizure and non-seizure groups.

Main Results:

• Seizures occurred in 31 patients (24%), predominantly within 24 hours of bleeding.
• Motor manifestations of partial seizures lacked lateralizing value for aneurysm site.
• Early mortality, rebleeding, and intracerebral hematoma rates were similar in both groups.
• Late seizures were infrequent in survivors with prior acute seizures.

Conclusions:

• Seizures are a common early complication of spontaneous subarachnoid hemorrhage.
• Early seizures do not appear to worsen short-term outcomes like mortality or rebleeding.
• The low incidence of late seizures questions the routine use of long-term prophylactic anticonvulsants.