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