Onset seizure as an isolated predictor of poor outcome after aneurysmal spontaneous subarachnoid hemorrhage

Ye.I. Tsoma, T.O. Studeniak, V.I. Smolanka, O.I. Borovik, S.V. Tsiapets


Background. Subarachnoid haemorhage (SAH) is a type of stroke and comprises 6–8 % of all strokes. Up to half of all cases of SAH are fatal, and 10–15 % of patients die before reaching a hospital, and those who survive could have neurological or cognitive impairment. Seizures occur in 13–24 % of patients with SAH, usually in the first 24 hours after the bleeding. Seizures can lead to increased cerebral blood flow, hypertension, and elevated intracranial pressure, thereby increasing the risk of re­bleeding and neurologic deterioration. The Hunt and Hess scale, Glasgow Coma Scale (GCS) and the World Federation of Neurosurgical Societies (WFNS) grading system have been shown to correlate well with disease outcome. But they do not consider onset seizure in SAH as a predictor of poor outcome. The purpose was to evaluate the prevalence of onset seizure in SAH and to investigate its effect on disease outcome, to develop a prognostic scale for examining patients with SAH that includes seizures as a bad prognostic predictor. Materials and methods. We have analyzed a series of 127 patients with SAH who were treated in our clinic from 2013 to 2016. All patients were examined using Hunt and Hess scale, WFNS grading system, and GCS. The prevalence of acute onset seizure has been found. All patients were screened using the developed Combined Patient Rating Scale. Disease outcomes after subarachnoid hemorrhage and treatment were assessed by Glasgow Outcome Scale. Results. Thirteen patients among 127 had seizures during disease onset. In each 10 patients, epileptic seizure was the first clinical symptom of SAH. The prevalence of seizures was 10.2 %, in addition, 5 of 13 cases with seizures were lethal, this was near 35.7 % of all fatal cases recorded in our group of patients. That’s why we have suggested that seizure in the onset of SAH is an isolated predictor of poor outcome. The Combined Patient Rating Scale has been developed and includes the criteria of seizure presence and/or absence in SAH onset. The mortality among patients who scored 5–6 points by this new scale was 77 %, 7–8 points — 100 %, respectively. Conclusions. Seizure in the onset of SAH is associated with an increased risk of death (p = 0.001). The Combined Patient Rating Scale in subarachnoid hemorrhage allows making an early outcome prognosis, correcting the treatment, prescribing intravenous antiepileptic drug and determines the best outcomes in patients.


subarachnoid haemorhage; saccular aneurysm; seizure; Glasgow Coma Scale; Hunt and Hess Scale; World Federation of Neurosurgical Societies grading system; Glasgow Outcome Scale; Combined Patient Rating Scale


Suarez J.I. Aneurysmal subarachnoid hemorrhage / J.I. Suarez, R.W. Tarr, W.R. Selman // New England Journal of Medicine. — Jan 2006. — P. 387-96.

Chou H.S. Outcomes after early anticonvulsant discontinuation in aneurismal subarahnoid hemorrhage / H.S. Chou, J.G. Latorre,

G. Alpargu // J. Vasc. Med. Surgery. — 2015. — Vol. 3. — P. 1-6.

van Gijn J. Subarachnoid hemorrhage: diagnosis, causes and management / J. van Gijn, G.J. Rinkel // Brain. — 2001. — P. 249-278.

Kyu-Sun Choi. Seizures and Epilepsy following Aneurysmal Subarachnoid Hemorrhage: Incidence and Risk Factors / Choi Kyu-Sun, Chun Hyoung-Joon, Yi Hyeong-Joong // J. Korean Neurosurg Soc. — 2009. — P. 93-98.

Baker C.J. Short-term perioperative anticonvulsant prophylaxis for the surgical treatment of low-risk patients with intracranial aneurysms / C.J. Baker, C.J. Prestigiacomo, R.A. Solomon // Neurosurgery. — 1995. — P. 863-70.

Byrne J.V. Seizures after aneurysmal subarachnoid hemorrhage treated with coil embolization / J.V. Byrne // Neurosurgery. — 2002. — P. 545-51.

Daniere F. Complications and follow up of subarachnoid he­morrhages / F. Daniere, G. Gascou, N. Menjot de Champfleur, P. Machi, N. Leboucq, C. Riquelme, C. Ruiz, A. Bonafe, V. Costalat // Diagnostic and Interventional Imaging. — 2015. — 96. —

P. 677-686.

Butzkueven H. Onset seizures independently predict poor outcome after subarachnoid hemorrhage / H. Butzkueven, A. Evans, E. Pitman, C. Leopold // Neurology. — 2000. — 55. — P. 1315-

Fung C. Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage / C. Fung, M. Balmer, M. Murek, W.J. Z’Graggen // J. Neurosurg. — 2015. —

P. 408-413.

Drake C.G. Report of World Federation of Neurological Surgeons committee on a universal subarachnoid hemorrhage grading scale / C.G. Drake, W.E. Hunt, K. Sano et al. // J. Neurosurgery. — 1988. — P. 985-986.

Gotoh O. Glasgow Coma Scale in the prediction of outcome after early aneurysm surgery / O. Gotoh, A. Tamura, N. Yasui, A. Suzuki, H. Hadeishi, K. Sano // Neurosurgery. — 1996. — P. 19-24.

Rosen D. Subarachnoid hemorrhage grading scales: A systematic review / D. Rosen, R. Macdonald // Neurocritical Care. — 2005. — Vol. 2. — P. 110-18.

De Marchis G.M. Tonic-Clonic Activity at Subarachnoid Hemorrhage Onset: Impact on Complications and Outcome / G.M. De Marchis, D. Pugin, H. Lantigua, C. Zammit, D. Pugin, H. Lantigua // PLoS ONE. — 2013. — Vol 8(8). — P. 1-8.

O’Connor, Kathryn L. High Risk for Seizures Following Subarachnoid Hemorrhage Regardless of Referral Bias / Kathryn L. O’Connor // Neurocrit Care. — Dec 2014. — P. 476-482.

Starke R.M. Rebleeding aneurysmal subarachnoid hemorrhage / R.M. Starke, E.S. Connolly // Neurocrit. Care. — 2011. — P. 241-6.

Mohamad Z. Authors Clinical Guide on «Seizures in Cerebrovascular Disorders» / Z. Mohamad. — June 2015.

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association // Stroke. — 2012. — 43. — P. 1711-1737.

Wang H. Levetiracetam is neuroprotective in murine mo-dels of closed head injury and subarachnoid hemorrhage / H. Wang, J. Gao, T.F. Lassiter et al. // Neurocrit. Care. — 2006. — Vol. 5. —

P. 71-78.

Feigin V.L. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies / V.L. Feigin, G.J. Rinkel, C.M. Lawes et al. // Stroke. — 2005. — Vol. 36(12). — P. 2773-2780.

Hackett M.L. Health outcomes 1 year after subarachnoid hemorrhage: an international population-based study / M.L. Hackett, C.S. Anderson // Neurology. — 2000. — P. 658-662.

Kellner C.P. Evaluation of a Revised Scale for the Prediction of Long-Term Outcome in Poor-Grade Aneurysmal Subarachnoid Hemorrhage Undergoing Operative Repair / C.P. Kellner // Neurosurgery. — Sep 2006. — P. 529-38.

Kowalski R.G. Initial misdiagnosis and outcome after subarachnoid hemorrhage / R.G. Kowalski, J. Claassen, K.T. Kreiter et al. // Journal of the American Medical Association. — Feb 2004. — P. 866-69.

Ravnik J. Long-term cognitive deficits in patients with good outcomes after aneurysmal subarachnoid hemorrhage from anterior communicating artery / J. Ravnik, B. Starovasnik, Z. Pirtošek, G. Bunc, R. Bošnjak // Croat. Med. J. — 2006. —

P. 253-263.

Rodriguez D.R. Predictor’s of Mortality in Patients with Aneurysmal Subarachnoid Haemorrhage and Reebleding / D.R. Rodriguez, C.S. Matamoros, L.F. Cue, J.L. Miranda Hernandez, Y.P. Sanchez, J.P. Nellar, Hindawi // Corporation Neurology Research International. — 2015. — P. 1-6.

Rooij N.K. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends / N.K. de Rooij, F.H. Linn, J.A. van der Plas, A. Algra, G.J.E. Rinkel // J. Neurol. Neurosurg. Psychiatry. — Dec 2007. — P. 1365-

Shiue I. Life events and risk of subarachnoid hemorrhage: the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS) / I. Shiue, H. Arima, C.S. Anderson // Stroke. — 2010. — P. 1304-1306.

van Gijn J. Subarachnoid haemorrhage / J. van Gijn, R.S. Kerr, G.J. Rinkel // Lancet. — 2007. — P. 306-18.

Vilkki J.S. Relationship of local infarctions to cognitive and psychosocial impairments after aneurysmal subarachnoid hemorrhage / J.S. Vilkki, S. Juvela, J. Siironen, T. Ilvo-nen, J. Varis, M. Porras // Neurosurgery. — 2004. — P. 790-

Visser-Meily J.M.A. Long-term health-related quality of life after aneurismal subarachnoid hemorrhage: relationship with psychological symptoms and personality characteristics / J.M.A. Visser-Meily, M.L. Rhebergen, G.J.E. Rinkel, M.J. van Zandvoort // Stroke. — 2009. — P. 1526-1529.


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