Abstracts

To evaluate the incidence and significance of cardiac contraction band necrosis (CBN) in patients who die during status epilepticus (SE). CBN has been observed in patients with subarachnoid hemorrhage and other life-threatening neurological emergencies. Massive catecholamine release may be the mechanism of CBN and cardiac arrhythmias that occur in these individuals. We retrospectively evaluated 28 patients who were derived from 54 consecutive patients with SE who underwent an autopsy between January 1975 and December 2003. The medical and pathological records were reviewed in all patients. Twenty six individuals were excluded because of an inability to confirm the diagnosis of SE or unavailability of cardiac anatomical specimens for examination. The 28 patients were divided into two groups: Group I- Died during refractory SE (n=11), Group II- Died remote from SE (n=17). The cardiac pathology in the two groups was compared to 22 randomly selected individuals (control group) who died without a known history of seizures. Nonconvulsive SE was confirmed by EEG studies. One investigator (EP) blinded to the clinical history and previous pathology reports reviewed the cardiac pathology slides for CBN. There were no significant differences in age, gender or history of heart disease between the three patient groups. Nine of the Group I patients had generalized convulsive SE and two patients had nonconvulsive SE. Eight of the 11 patients in Group I had CBN compared to 5 of 22 patients in the control group (p[lt] 0.01, Fisher[apos]s exact test). Three of 17 patients in Group II had CBN compared to 5 of 22 patients in the control group (p=1.0, Fisher[apos]s exact test). CBN occurred more frequently in Group I patients than Group II patients (p[lt] .01, Fisher[apos]s exact test). Cardiac CBN was identified in most patients in this series who died during an episode of SE. This specific anatomical pathology was uncommon in patients with a remote history of SE or an age-matched control group. This study provides compelling evidence that cardiac CBN may be a potential pathophysiology for cardiac decompensation and death in individuals with SE or seizure activity. (Supported by Mayo Foundation.)