Abstracts

Nontraumatic intracerebral hemorrhage is bleeding into the parenchyma of the brain that may extend into the ventricles and, in rare cases, the subarachnoid space. Each year, approximately 37,000 to 52,400 people in the United States have an intracerebral hemorrhage.
Seizures associated with nontraumatic ICH have not been fully characterized. There is little information relating seizures to clinical presentation, course, or outcome in ICH and the existing data do not define the role of anticonvulsants during the acute hospitalization for ICH.
This study addresses these issues through a retrospective evaluation of patients with hypertensive ICH., We analyzed 123 consecutive admissions to our NICU between 12/2005 and 5/2006. Subjects with head trauma, brain neoplasm, aneurysms or any etiology to explain the ICH besides hypertension (HTN) were excluded. 78 ICH met the criteriaClinical features, timing of seizures relative to hemorrhage onset, factors predisposing to ICH, including HTN, bleeding diathesis (thrombocytopenia or anticoagulation therapy), worsening of clinical and radiographic findings after the seizure were assessed., Demographics: Median age 62.8, range 35 to 90 years. Ethnicity: African American 59%, Caucasian 25%, Hispanic 11.5% and Asian 4% .
85.9% had Chronic HTN and 33% had prior CVA; 4 subjects had history of seizures.
Average BP on admission was 170/95. Fourteen patients were coagulopathic.
Clinical presenting features were: change in mental status 35%, Hemiparesis 25.6%, Headache18 %, Aphasia 5%, and Seizure 2.5%.
ICH location: Basal ganglia/thalamus 51.2%, Lobar 41%, Cerebellar 2.5%, and Pons 3.8%. Intraventricular extension occurred in 38.4%.
Of 78 subjects, 2 had seizures, both upon presentation, both with prior seizures. 75 subjects were evaluated for AED prophylaxis (AEDP). 23 (30%) received AEDP. Lobar hemorrhages comprised 46% of AEDP but only 32% of the no AEDP group.
Average ICU stay for all subjects was 7.8 days compared to subjects who received AED 10.6 days and subjects who did not receive AED 6.2 days.
Adverse effects attributed to AEDP included fever, abnormal liver functions and hypotension.
Based on one-way ANOVA there was a significant difference on length of stay between subjects who did not receive AED prophylactic and those who did (F = 5.52, p = 0.022)., In this series of HTN ICH, the incidence of acute seizures was 2.6% and those subjects with seizures had antecedent epilepsy. This contrasts to previous reports. Features of our population would suggest a greater tendency to seizure. Subjects with seizures had their ictal event at or shortly after, hemorrhage onset, a finding previously reported.
In our series 23 subjects received prophylactic AED therapy; however none of the remaining 55 subjects had clinical seizures during their hospital stay. Additionally, those who received AEDs had longer ICU stays and increased non-neurologic complications.,