Hyperemia in subarachnoid hemorrhage patients is associated with an increased risk of seizures

• Published in: Journal of cerebral blood flow and metabolism Vol. 40; no. 6; pp. 1290 - 1299
• Main Authors: Alkhachroum, Ayham, Megjhani, Murad, Terilli, Kalijah, Rubinos, Clio, Ford, Jenna, Wallace, Brendan K, Roh, David J, Agarwal, Sachin, Connolly, E Sander, Boehme, Amelia K, Claassen, Jan, Park, Soojin
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.06.2020
• Subjects: Aged; Brain - blood supply; Brain - physiopathology; Cerebrovascular Circulation - physiology; Female; Homeostasis - physiology; Humans; Hyperemia - etiology; Hyperemia - physiopathology; Male; Middle Aged; Original; Risk Factors; Seizures - etiology; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - physiopathology; cerebral perfusion; subarachnoid hemorrhage; ictal-interictal continuum; electroencephalogram; Seizures
• ISSN: 0271-678X; 1559-7016; 1559-7016
• DOI: 10.1177/0271678X19863028

The association between impaired brain perfusion, cerebrovascular reactivity status and the risk of ictal events in patients with subarachnoid hemorrhage is unknown. We identified 13 subarachnoid hemorrhage (SAH) patients with seizures and 22 with ictal-interictal continuum (IIC), and compared multimodality physiological recordings to 38 similarly poor-grade SAH patients without ictal activity. We analyzed 10,179 cumulative minutes of seizure and 12,762 cumulative minutes of IIC. Cerebrovascular reactivity (PRx) was not different between subjects with seizures, IIC, or controls. Cerebral perfusion pressure (CPP) was higher in patients with seizures [99 ± 6.5, p = .005] and IIC [97 ± 8.5, p = .007] when compared to controls [89 ± 12.3]. DeltaCPP, defined as actual CPP minus optimal CPP (CPPopt), was also higher in the seizure group [8.3 ± 7.9, p = .0003] and IIC [8.1 ± 10.3, p = .0006] when compared to controls [−0.1 ± 5]. Time spent with supra-optimal CPP was higher in the seizure group [342 ± 213 min/day, p = .002] when compared to controls [154 ± 120 min/day]. In a temporal examination, a supra-optimal CPP preceded increased seizures and IIC in SAH patients, an hour before and continued to increase during the events [p < .0001].