Background: Patients with intracerebral hemorrhages (ICH) have a higher incidence of seizures. Previous studies have suggested that the location and size of hemorrhage may increase epileptogenicity. We aim to evaluate seizure development risk factors from clinical examination, imaging, and continuous electroencephalography (CEEG) in critically ill patients with ICH.
Methods: We reviewed 57 consecutive patients with ICH admitted to a neurocritical intensive care unit over a 24-month period who were monitored on CEEG. Their demographic and examination data, ICH score, Glasgow coma scale (GCS), location of bleed, CEEG patterns, and discharge status were analyzed.
Results: Sixteen (28%) patients from our study cohort had seizures at a mean duration of 7.46 hours from CEEG hookup. Fifteen (93%) of those patients had electrographic only seizures. The finding of lateralized periodic discharges (LPDs) was significantly (p=0.019) associated with seizures. Other variables, such as ICH score, size and location of hemorrhage, GCS, mental status, and other CEEG patterns, were not significantly associated with seizures.
Conclusion: We found that LPDs were predictive of seizures in ICH patients. CEEG for longer than 24-hours is preferred for detection of seizures as they occurred at a mean later than seven hours and most were without clinical signs.