The Experts below are selected from a list of 3615 Experts worldwide ranked by ideXlab platform
Emily J. Gilmore - One of the best experts on this subject based on the ideXlab platform.
-
Deep Versus Lobar Intraparenchymal Hemorrhage: Seizures, Hyperexcitable Patterns, and Clinical Outcomes.
Critical care medicine, 2020Co-Authors: Zubeda B. Sheikh, Christoph Stretz, Carolina B. Maciel, Monica B. Dhakar, Hailey Orgass, Ognen A. C. Petroff, Lawrence J. Hirsch, Emily J. GilmoreAbstract:To compare electrographic seizures, hyperexcitable patterns, and clinical outcomes in lobar and deep Intraparenchymal Hemorrhage. Additionally, to characterize electrographic seizure and hyperexcitable pattern predictors in each group and determine seizure risk with thalamic involvement. Retrospective cohort study. Tertiary academic medical center. Consecutive adult patients with nontraumatic Intraparenchymal Hemorrhage undergoing continuous electroencephalography at our center between January 2013 and December 2016. Not applicable. Based on head CT closest to the initial continuous electroencephalography session, we classified Intraparenchymal Hemorrhage as isolated deep (no insular, subarachnoid, subdural extension) or lobar. Hyperexcitable patterns included the following: periodic discharges, spike-wave complexes, any rhythmic delta other than generalized. We used Fisher exact test for categorical and Mann-Whitney U test for continuous variables. Multivariable regression identified predictors of electrographic seizures, hyperexcitable patterns, and poor outcomes (score of 1-2 on Glasgow Outcome Scale) in lobar Intraparenchymal Hemorrhage. The cohort comprised of 128 patients, 88 lobar, and 40 deep Intraparenchymal Hemorrhage. Electrographic seizures occurred in 17% of lobar and 5% of deep Intraparenchymal Hemorrhage (p = 0.09). Hyperexcitable patterns were more frequent in the lobar group (44.3% vs 17.5%; p = 0.005). In multivariable analyses in the lobar group, lateralized rhythmic delta activity predicted electrographic seizures (odds ratio, 6.24; CI, 1.49-26.08; p = 0.012); insular involvement predicted hyperexcitable patterns (odds ratio, 4.88; CI, 1.36-17.57; p = 0.015); coma, temporal lobe involvement, Intraparenchymal Hemorrhage volume, and electrographic seizures predicted poor outcome. Thalamic involvement did not affect electrographic seizures or hyperexcitable patterns in either group. Electrographic seizures are frequent in lobar Intraparenchymal Hemorrhage, occurring in one in six monitored patients, as opposed to only 5% in isolated deep Intraparenchymal Hemorrhage not extending to cortex/insula, subarachnoid, or subdural spaces. Patients with lobar Intraparenchymal Hemorrhage and lateralized rhythmic delta activity were six times as likely to have electrographic seizures, which were associated with 5.47 higher odds of a poor outcome. Coma, temporal lobe involvement, hematoma volume, and electrographic seizures predicted poor outcome in lobar Intraparenchymal Hemorrhage.
-
deep versus lobar Intraparenchymal Hemorrhage seizures hyperexcitable patterns and clinical outcomes
Critical Care Medicine, 2020Co-Authors: Zubeda Sheikh, Christoph Stretz, Carolina B. Maciel, Monica B. Dhakar, Hailey Orgass, Ognen A. C. Petroff, Lawrence J. Hirsch, Emily J. GilmoreAbstract:OBJECTIVES To compare electrographic seizures, hyperexcitable patterns, and clinical outcomes in lobar and deep Intraparenchymal Hemorrhage. Additionally, to characterize electrographic seizure and hyperexcitable pattern predictors in each group and determine seizure risk with thalamic involvement. DESIGN Retrospective cohort study. SETTING Tertiary academic medical center. PATIENTS Consecutive adult patients with nontraumatic Intraparenchymal Hemorrhage undergoing continuous electroencephalography at our center between January 2013 and December 2016. INTERVENTIONS Not applicable. MEASUREMENTS AND MAIN RESULTS Based on head CT closest to the initial continuous electroencephalography session, we classified Intraparenchymal Hemorrhage as isolated deep (no insular, subarachnoid, subdural extension) or lobar. Hyperexcitable patterns included the following: periodic discharges, spike-wave complexes, any rhythmic delta other than generalized. We used Fisher exact test for categorical and Mann-Whitney U test for continuous variables. Multivariable regression identified predictors of electrographic seizures, hyperexcitable patterns, and poor outcomes (score of 1-2 on Glasgow Outcome Scale) in lobar Intraparenchymal Hemorrhage. The cohort comprised of 128 patients, 88 lobar, and 40 deep Intraparenchymal Hemorrhage. Electrographic seizures occurred in 17% of lobar and 5% of deep Intraparenchymal Hemorrhage (p = 0.09). Hyperexcitable patterns were more frequent in the lobar group (44.3% vs 17.5%; p = 0.005). In multivariable analyses in the lobar group, lateralized rhythmic delta activity predicted electrographic seizures (odds ratio, 6.24; CI, 1.49-26.08; p = 0.012); insular involvement predicted hyperexcitable patterns (odds ratio, 4.88; CI, 1.36-17.57; p = 0.015); coma, temporal lobe involvement, Intraparenchymal Hemorrhage volume, and electrographic seizures predicted poor outcome. Thalamic involvement did not affect electrographic seizures or hyperexcitable patterns in either group. CONCLUSIONS Electrographic seizures are frequent in lobar Intraparenchymal Hemorrhage, occurring in one in six monitored patients, as opposed to only 5% in isolated deep Intraparenchymal Hemorrhage not extending to cortex/insula, subarachnoid, or subdural spaces. Patients with lobar Intraparenchymal Hemorrhage and lateralized rhythmic delta activity were six times as likely to have electrographic seizures, which were associated with 5.47 higher odds of a poor outcome. Coma, temporal lobe involvement, hematoma volume, and electrographic seizures predicted poor outcome in lobar Intraparenchymal Hemorrhage.
-
f80 seizures and hyperexcitable eeg patterns in spontaneous deep Intraparenchymal Hemorrhage
Clinical Neurophysiology, 2018Co-Authors: Zubeda Sheikh, Christoph Stretz, Carolina B. Maciel, Monica B. Dhakar, Lawrence J. Hirsch, Emily J. GilmoreAbstract:Introduction The incidence of electrographic seizures after non-traumatic Intraparenchymal Hemorrhage (IPH) ranges from 1.7% to 31%. It is unclear if the risk of seizures or hyperexcitable patterns (HEPs: any rhythmic delta activity except generalized, any periodic discharges, or any spike-wave pattern, using ACNS criteria) for deep IPH is similar to lobar, subarachnoid and subdural Hemorrhages. We hypothesized that the incidence of seizures or hyperexcitable patterns (SZ or HEPs) in deep IPH is lower than reported, but thalamic involvement may confer higher risk due to its role in physiologic and pathologic rhythmic activity, such as sleep spindles and generalized spike wave discharges. Methods On retrospective review, 45 patients had deep IPH (defined as IPH not involving cortex/juxtacortical regions other than the insula (analyzed separately), with or without intraventricular Hemorrhage IVH) and underwent continuous EEG (cEEG) between 1/2013 and 12/2016. Patients with involvement of cortex, subarachnoid or subdural areas were excluded. Age, sex, prior history of epilepsy, clinical seizure at ictus, anti-seizure drugs (ASDs), sedative infusions during EEG and surgical interventions such as ventriculostomy (EVD) or decompressive hemicraniectomy (DHC) were reviewed. The cEEG closest to admission was reviewed for seizures, HEPs, and generalized rhythmic delta activity (GRDA). The head CT in closest proximity to the index cEEG was reviewed for hematoma volume, thalamic involvement and insular involvement. Results Two of 45 patients had SZ, 7/45 had HEPs, 1/45 had both and a total of 8/45 had SZ or HEPs. Of the HEPs , LRDA was seen in 4/8, LPDs in 2/8, both LPDs and LRDA in 1/8. Of those with the lateralized HEPs, 4/7 were contralateral to IPH, 1/7 (14.2%) were bilateral and 2/7 were ipsilateral. Of the 5/7 with HEPs contralateral to the IPH, 2 had an EVD ipsilateral to the HEPs. Patients with SZ or HEPs had significantly higher hematoma volume compared to patients who did not have SZ or HEPs (32.7 ± 19.4 vs 15.4 ± 17.7, p = 0.02). Patients who underwent surgery (DHC/EVD or both) had higher incidence of HEPs or SZ compared to those who did not (7/23, 30.4% vs 1/22, 4.5%, p = 0.047). DHC was associated with significantly higher risk of SZ or HEPs (4/4, 100% vs 4/41, 9.8%, p Conclusion Risk of SZ or HEPs with deep IPH ± IVH was 17.7% and correlated with mean hematoma volume and DHC. The, risk in the absence of a surgical intervention was low (1/22, 4.5%, vs 7/23, 30.4% p = 0.047). Thalamic involvement did not correlate with SZ or HEPs in this small cohort of patients with deep IPH.
Ali Alaraj - One of the best experts on this subject based on the ideXlab platform.
-
intracranial contrast transit times on digital subtraction angiography decrease more in patients with delayed Intraparenchymal Hemorrhage after pipeline
Interventional Neuroradiology, 2018Co-Authors: Denise Brunozzi, Sophia F Shakur, Fady T Charbel, Ali AlarajAbstract:BackgroundPipeline embolization devices (PEDs) are used for endovascular treatment of cerebral aneurysms but can be associated with delayed ipsilateral Intraparenchymal Hemorrhage (DIPH). Changes i...
-
middle cerebral artery flow velocity increases more in patients with delayed Intraparenchymal Hemorrhage after pipeline
Journal of NeuroInterventional Surgery, 2018Co-Authors: Denise Brunozzi, Sophia F Shakur, Fady T Charbel, Ahmed E Hussein, Ali AlarajAbstract:Objective Pipeline Embolization Devices (PED) are commonly used for endovascular treatment of cerebral aneurysms but can be associated with delayed ipsilateral Intraparenchymal Hemorrhage (DIPH). The role that altered intracranial hemodynamics may play in the pathophysiology of DIPH is poorly understood. We assess middle cerebral artery (MCA) flow velocity changes after PED deployment. Materials and methods Patients with aneurysms located proximal to the internal carotid artery terminus treated with PED at our institution between 2015 and 2016 were retrospectively reviewed. Patients were included if MCA flow velocities were measured using transcranial Doppler. Bilateral MCA flow velocities, ratio of ipsilateral to contralateral MCA flow velocity, and bilateral MCA pulsatility index before and after PED deployment were assessed. Results 10 patients of mean age 52 years were included. Two patients had DIPH within 48 hours after PED deployment. We observed that these two patients had a higher increase in ipsilateral MCA mean flow velocity after treatment compared with patients without DIPH (39.5% vs 5.5%). Additionally, before PED deployment, patients with DIPH had a higher ipsilateral MCA pulsatility index (1.55 vs 0.98) and a higher ratio of ipsilateral to contralateral MCA mean flow velocity (1.35 vs 1.04). Conclusions After PED, ipsilateral MCA mean flow velocity increases more in patients with DIPH. These flow velocity changes suggest the possible role of altered distal intracranial hemodynamics in DIPH after PED treatment of cerebral aneurysms. Further data are required to confirm this observation.
-
Intracranial contrast transit times on digital subtraction angiography decrease more in patients with delayed Intraparenchymal Hemorrhage after Pipeline
Interventional neuroradiology : journal of peritherapeutic neuroradiology surgical procedures and related neurosciences, 2017Co-Authors: Denise Brunozzi, Sophia F Shakur, Fady T Charbel, Ali AlarajAbstract:Background Pipeline embolization devices (PEDs) are used for endovascular treatment of cerebral aneurysms but can be associated with delayed ipsilateral Intraparenchymal Hemorrhage (DIPH). Changes in intracranial hemodynamics after PED are poorly understood. Objective Here, we assess hemodynamic changes after PED in patients and compare these changes in patients with and without DIPH (DIPH+ and DIPH-). Methods Records of patients with distal internal carotid artery (ICA) aneurysms treated with PED at our institution between 2012 and 2017 were retrospectively reviewed. Regions of interest were selected proximally to PED over the cavernous ICA and distally over the middle cerebral artery (MCA), and then transit times were determined using syngo iFlow software (Siemens). Ratio of MCA to ICA transit time was compared before, after treatment, and at follow-up. Ratios were also compared between DIPH+ and DIPH- subgroups. Correlations between aneurysm size, age, and ratios were investigated. Results Fifty-three patients were included. The ratio of MCA to ICA transit time decreased significantly after PED deployment (1.13 vs. 1.22, p
-
thresholds for volume and expansion in Intraparenchymal Hemorrhage predictors of neurologic deterioration and mortality
World Neurosurgery, 2017Co-Authors: Darian R Esfahani, Fady T Charbel, Caitlin A Radnis, Ahmed E Hussein, Sepideh Aminhanjani, Ali AlarajAbstract:Objective Spontaneous Intraparenchymal Hemorrhage (IPH) is a common neurosurgical emergency, with Hemorrhage size and expansion associated with poor clinical outcomes. In this study, radiologic risk factors and specific IPH volume thresholds were calculated to identify heightened risk of neurologic deterioration and mortality. Methods A consecutive review of all patients with nontraumatic IPH transferred to a tertiary academic neurosurgery service was performed over 2 years. IPH volume, Hemorrhage location, presence of intraventricular Hemorrhage, hydrocephalus, anticoagulant use, and neurologic status were reviewed. A maximum Youden index was calculated to determine thresholds of initial IPH volume and expansion most predictive of deterioration and mortality. Results A total of 202 transfers were studied. Both initial IPH volume at the outside hospital and IPH expansion were correlated with neurologic deterioration and death. The most predictive threshold for mortality was 32 mL of initial IPH volume (area under the curve 0.758, P Conclusions Volume and growth of IPH are significant predictors of neurologic deterioration and death. An initial volume over 32 mL is associated with increased mortality risk, whereas risk of neurologic deterioration appears to peak at a smaller volume of 18 mL. Any measurable IPH expansion suggests elevated risk of deterioration and mortality.
-
Thresholds for Volume and Expansion in Intraparenchymal Hemorrhage: Predictors of Neurologic Deterioration and Mortality.
World neurosurgery, 2017Co-Authors: Darian R Esfahani, Fady T Charbel, Caitlin A Radnis, Ahmed E Hussein, Sepideh Amin-hanjani, Ali AlarajAbstract:Spontaneous Intraparenchymal Hemorrhage (IPH) is a common neurosurgical emergency, with Hemorrhage size and expansion associated with poor clinical outcomes. In this study, radiologic risk factors and specific IPH volume thresholds were calculated to identify heightened risk of neurologic deterioration and mortality. A consecutive review of all patients with nontraumatic IPH transferred to a tertiary academic neurosurgery service was performed over 2 years. IPH volume, Hemorrhage location, presence of intraventricular Hemorrhage, hydrocephalus, anticoagulant use, and neurologic status were reviewed. A maximum Youden index was calculated to determine thresholds of initial IPH volume and expansion most predictive of deterioration and mortality. A total of 202 transfers were studied. Both initial IPH volume at the outside hospital and IPH expansion were correlated with neurologic deterioration and death. The most predictive threshold for mortality was 32 mL of initial IPH volume (area under the curve 0.758, P < 0.001, confidence interval 1.012-1.035) and 1 mL of expansion. The threshold for neurologic deterioration was 18 mL of initial volume (area under the curve 0.690, P = 0.004, confidence interval 1.004-1.025) and 1 mL of expansion. Both intraventricular Hemorrhage and hydrocephalus were independently associated with elevated risk for deterioration and mortality, while anticoagulant use was associated with neurologic deterioration. Volume and growth of IPH are significant predictors of neurologic deterioration and death. An initial volume over 32 mL is associated with increased mortality risk, whereas risk of neurologic deterioration appears to peak at a smaller volume of 18 mL. Any measurable IPH expansion suggests elevated risk of deterioration and mortality. Copyright © 2017 Elsevier Inc. All rights reserved.
Jill M Scholz - One of the best experts on this subject based on the ideXlab platform.
-
Incidence of delayed ipsilateral Intraparenchymal Hemorrhage after stent-assisted coiling of intracranial aneurysms in a high-volume single center.
Neuroradiology, 2015Co-Authors: Yasha Kayan, Josser E. Delgado Almandoz, Jennifer L Fease, K Tran, Anna M Milner, Jill M ScholzAbstract:Delayed ipsilateral Intraparenchymal Hemorrhage (IPH) has been reported following technically successful treatment of intracranial aneurysms using flow-diverting stents in up to 8.5% of patients. We report a similar, though less frequent phenomenon in the setting of stent-assisted coil embolization. Institutional review board approval was obtained. A retrospective analysis of a prospective neurointerventional procedure registry was performed to review all IPHs that occurred in aneurysm patients within 90 days of endovascular treatment performed between November 2002 and November 2014 at one institution. Age, sex, hypertension, dual antiplatelet therapy, and technical details of the procedure were recorded. A total of 1697 patients underwent endovascular treatment of an intracranial aneurysm without a flow diverter at our institution during the study period. Among these, 138 patients underwent stent-assisted coiling (8.1%). Of these, three patients (2.2%) suffered a delayed IPH within the vascular territory distal to the treated lesion (one woman, median age 60 years). Recently described in the setting of flow diversion, delayed ipsilateral IPH is not limited to flow-diverting stents. Though less frequent, a potential for this complication may exist following any intracranial stenting procedure, possibly related to hemorrhagic conversion of microembolic phenomena in the setting of dual antiplatelet or anticoagulation therapy.
-
Abstract TP84: Delayed Ipsilateral Intraparenchymal Hemorrhage After Neuroform Stent Assisted Coiling of Intracranial Aneurysms
Stroke, 2013Co-Authors: Yasha Kadkhodayan, Josser E. Delgado Almandoz, Jennifer L Fease, B Crandall, Jill M Scholz, R Anderson, David E TubmanAbstract:Background: Delayed ipsilateral Intraparenchymal Hemorrhage (IPH) has been reported following technically successful treatment of intracranial aneurysms using flow-diverting stents (Pipeline embolization device) in 8.5% of patients and does not appear to be related entirely to dual antiplatelet therapy. We report a similar phenomenon in Neuroform-assisted coiling. Methods: Neuroform-assisted coiling patients were entered into a prospective registry at our institution. Procedural and 30 day complications were recorded. Delayed ipsilateral IPH cases within 30 days were reviewed. Results: Between 11/2002 and 7/2012, 98 patients had Neuroform-assisted coiling of 100 cerebral aneurysms, 8 acutely ruptured. Intra-procedurally, there were 3 thromboembolic events and 4 Hemorrhages due to vessel or aneurysm perforation (not necessarily symptomatic). After the procedure but within 30 days follow-up (available for 92 patients), there were 6 TIA’s, 2 minor strokes and 1 SAH. There were 2 cases of ipsilateral IPH (2%). One was a 60-year-old man who had stent-assisted coiling of an ACOM aneurysm (Neuroform from right A1 into left A2). He was on aspirin 81 mg and clopidogrel 75 mg daily with a PRU (P2Y12 reaction units) of 72 on day of procedure. Despite decreasing clopidogrel dosing to every other day, he had a frontal lobe IPH 7 days later (Figure 1) with a PRU of 59. The other IPH (Figure 2) occurred in a 70-year-old man 14 days after Y-stent assisted coiling of an MCA aneurysm. He was on clopidogrel 75 mg and warfarin (INR 2.0) for prior pulmonary embolism and dural venous sinus thrombosis. Both patients recovered without neurological deficit. Conclusion: Recently described in flow diversion, delayed ipsilateral IPH is not limited to flow-diverting stents. Though less frequent, a potential for this may exist following any intracranial stenting procedure, possibly related to hemorrhagic conversion of microembolic phenomenon while on dual antiplatelets or anticoagulation.
Christoph Stretz - One of the best experts on this subject based on the ideXlab platform.
-
Deep Versus Lobar Intraparenchymal Hemorrhage: Seizures, Hyperexcitable Patterns, and Clinical Outcomes.
Critical care medicine, 2020Co-Authors: Zubeda B. Sheikh, Christoph Stretz, Carolina B. Maciel, Monica B. Dhakar, Hailey Orgass, Ognen A. C. Petroff, Lawrence J. Hirsch, Emily J. GilmoreAbstract:To compare electrographic seizures, hyperexcitable patterns, and clinical outcomes in lobar and deep Intraparenchymal Hemorrhage. Additionally, to characterize electrographic seizure and hyperexcitable pattern predictors in each group and determine seizure risk with thalamic involvement. Retrospective cohort study. Tertiary academic medical center. Consecutive adult patients with nontraumatic Intraparenchymal Hemorrhage undergoing continuous electroencephalography at our center between January 2013 and December 2016. Not applicable. Based on head CT closest to the initial continuous electroencephalography session, we classified Intraparenchymal Hemorrhage as isolated deep (no insular, subarachnoid, subdural extension) or lobar. Hyperexcitable patterns included the following: periodic discharges, spike-wave complexes, any rhythmic delta other than generalized. We used Fisher exact test for categorical and Mann-Whitney U test for continuous variables. Multivariable regression identified predictors of electrographic seizures, hyperexcitable patterns, and poor outcomes (score of 1-2 on Glasgow Outcome Scale) in lobar Intraparenchymal Hemorrhage. The cohort comprised of 128 patients, 88 lobar, and 40 deep Intraparenchymal Hemorrhage. Electrographic seizures occurred in 17% of lobar and 5% of deep Intraparenchymal Hemorrhage (p = 0.09). Hyperexcitable patterns were more frequent in the lobar group (44.3% vs 17.5%; p = 0.005). In multivariable analyses in the lobar group, lateralized rhythmic delta activity predicted electrographic seizures (odds ratio, 6.24; CI, 1.49-26.08; p = 0.012); insular involvement predicted hyperexcitable patterns (odds ratio, 4.88; CI, 1.36-17.57; p = 0.015); coma, temporal lobe involvement, Intraparenchymal Hemorrhage volume, and electrographic seizures predicted poor outcome. Thalamic involvement did not affect electrographic seizures or hyperexcitable patterns in either group. Electrographic seizures are frequent in lobar Intraparenchymal Hemorrhage, occurring in one in six monitored patients, as opposed to only 5% in isolated deep Intraparenchymal Hemorrhage not extending to cortex/insula, subarachnoid, or subdural spaces. Patients with lobar Intraparenchymal Hemorrhage and lateralized rhythmic delta activity were six times as likely to have electrographic seizures, which were associated with 5.47 higher odds of a poor outcome. Coma, temporal lobe involvement, hematoma volume, and electrographic seizures predicted poor outcome in lobar Intraparenchymal Hemorrhage.
-
deep versus lobar Intraparenchymal Hemorrhage seizures hyperexcitable patterns and clinical outcomes
Critical Care Medicine, 2020Co-Authors: Zubeda Sheikh, Christoph Stretz, Carolina B. Maciel, Monica B. Dhakar, Hailey Orgass, Ognen A. C. Petroff, Lawrence J. Hirsch, Emily J. GilmoreAbstract:OBJECTIVES To compare electrographic seizures, hyperexcitable patterns, and clinical outcomes in lobar and deep Intraparenchymal Hemorrhage. Additionally, to characterize electrographic seizure and hyperexcitable pattern predictors in each group and determine seizure risk with thalamic involvement. DESIGN Retrospective cohort study. SETTING Tertiary academic medical center. PATIENTS Consecutive adult patients with nontraumatic Intraparenchymal Hemorrhage undergoing continuous electroencephalography at our center between January 2013 and December 2016. INTERVENTIONS Not applicable. MEASUREMENTS AND MAIN RESULTS Based on head CT closest to the initial continuous electroencephalography session, we classified Intraparenchymal Hemorrhage as isolated deep (no insular, subarachnoid, subdural extension) or lobar. Hyperexcitable patterns included the following: periodic discharges, spike-wave complexes, any rhythmic delta other than generalized. We used Fisher exact test for categorical and Mann-Whitney U test for continuous variables. Multivariable regression identified predictors of electrographic seizures, hyperexcitable patterns, and poor outcomes (score of 1-2 on Glasgow Outcome Scale) in lobar Intraparenchymal Hemorrhage. The cohort comprised of 128 patients, 88 lobar, and 40 deep Intraparenchymal Hemorrhage. Electrographic seizures occurred in 17% of lobar and 5% of deep Intraparenchymal Hemorrhage (p = 0.09). Hyperexcitable patterns were more frequent in the lobar group (44.3% vs 17.5%; p = 0.005). In multivariable analyses in the lobar group, lateralized rhythmic delta activity predicted electrographic seizures (odds ratio, 6.24; CI, 1.49-26.08; p = 0.012); insular involvement predicted hyperexcitable patterns (odds ratio, 4.88; CI, 1.36-17.57; p = 0.015); coma, temporal lobe involvement, Intraparenchymal Hemorrhage volume, and electrographic seizures predicted poor outcome. Thalamic involvement did not affect electrographic seizures or hyperexcitable patterns in either group. CONCLUSIONS Electrographic seizures are frequent in lobar Intraparenchymal Hemorrhage, occurring in one in six monitored patients, as opposed to only 5% in isolated deep Intraparenchymal Hemorrhage not extending to cortex/insula, subarachnoid, or subdural spaces. Patients with lobar Intraparenchymal Hemorrhage and lateralized rhythmic delta activity were six times as likely to have electrographic seizures, which were associated with 5.47 higher odds of a poor outcome. Coma, temporal lobe involvement, hematoma volume, and electrographic seizures predicted poor outcome in lobar Intraparenchymal Hemorrhage.
-
f80 seizures and hyperexcitable eeg patterns in spontaneous deep Intraparenchymal Hemorrhage
Clinical Neurophysiology, 2018Co-Authors: Zubeda Sheikh, Christoph Stretz, Carolina B. Maciel, Monica B. Dhakar, Lawrence J. Hirsch, Emily J. GilmoreAbstract:Introduction The incidence of electrographic seizures after non-traumatic Intraparenchymal Hemorrhage (IPH) ranges from 1.7% to 31%. It is unclear if the risk of seizures or hyperexcitable patterns (HEPs: any rhythmic delta activity except generalized, any periodic discharges, or any spike-wave pattern, using ACNS criteria) for deep IPH is similar to lobar, subarachnoid and subdural Hemorrhages. We hypothesized that the incidence of seizures or hyperexcitable patterns (SZ or HEPs) in deep IPH is lower than reported, but thalamic involvement may confer higher risk due to its role in physiologic and pathologic rhythmic activity, such as sleep spindles and generalized spike wave discharges. Methods On retrospective review, 45 patients had deep IPH (defined as IPH not involving cortex/juxtacortical regions other than the insula (analyzed separately), with or without intraventricular Hemorrhage IVH) and underwent continuous EEG (cEEG) between 1/2013 and 12/2016. Patients with involvement of cortex, subarachnoid or subdural areas were excluded. Age, sex, prior history of epilepsy, clinical seizure at ictus, anti-seizure drugs (ASDs), sedative infusions during EEG and surgical interventions such as ventriculostomy (EVD) or decompressive hemicraniectomy (DHC) were reviewed. The cEEG closest to admission was reviewed for seizures, HEPs, and generalized rhythmic delta activity (GRDA). The head CT in closest proximity to the index cEEG was reviewed for hematoma volume, thalamic involvement and insular involvement. Results Two of 45 patients had SZ, 7/45 had HEPs, 1/45 had both and a total of 8/45 had SZ or HEPs. Of the HEPs , LRDA was seen in 4/8, LPDs in 2/8, both LPDs and LRDA in 1/8. Of those with the lateralized HEPs, 4/7 were contralateral to IPH, 1/7 (14.2%) were bilateral and 2/7 were ipsilateral. Of the 5/7 with HEPs contralateral to the IPH, 2 had an EVD ipsilateral to the HEPs. Patients with SZ or HEPs had significantly higher hematoma volume compared to patients who did not have SZ or HEPs (32.7 ± 19.4 vs 15.4 ± 17.7, p = 0.02). Patients who underwent surgery (DHC/EVD or both) had higher incidence of HEPs or SZ compared to those who did not (7/23, 30.4% vs 1/22, 4.5%, p = 0.047). DHC was associated with significantly higher risk of SZ or HEPs (4/4, 100% vs 4/41, 9.8%, p Conclusion Risk of SZ or HEPs with deep IPH ± IVH was 17.7% and correlated with mean hematoma volume and DHC. The, risk in the absence of a surgical intervention was low (1/22, 4.5%, vs 7/23, 30.4% p = 0.047). Thalamic involvement did not correlate with SZ or HEPs in this small cohort of patients with deep IPH.
Carolina B. Maciel - One of the best experts on this subject based on the ideXlab platform.
-
Deep Versus Lobar Intraparenchymal Hemorrhage: Seizures, Hyperexcitable Patterns, and Clinical Outcomes.
Critical care medicine, 2020Co-Authors: Zubeda B. Sheikh, Christoph Stretz, Carolina B. Maciel, Monica B. Dhakar, Hailey Orgass, Ognen A. C. Petroff, Lawrence J. Hirsch, Emily J. GilmoreAbstract:To compare electrographic seizures, hyperexcitable patterns, and clinical outcomes in lobar and deep Intraparenchymal Hemorrhage. Additionally, to characterize electrographic seizure and hyperexcitable pattern predictors in each group and determine seizure risk with thalamic involvement. Retrospective cohort study. Tertiary academic medical center. Consecutive adult patients with nontraumatic Intraparenchymal Hemorrhage undergoing continuous electroencephalography at our center between January 2013 and December 2016. Not applicable. Based on head CT closest to the initial continuous electroencephalography session, we classified Intraparenchymal Hemorrhage as isolated deep (no insular, subarachnoid, subdural extension) or lobar. Hyperexcitable patterns included the following: periodic discharges, spike-wave complexes, any rhythmic delta other than generalized. We used Fisher exact test for categorical and Mann-Whitney U test for continuous variables. Multivariable regression identified predictors of electrographic seizures, hyperexcitable patterns, and poor outcomes (score of 1-2 on Glasgow Outcome Scale) in lobar Intraparenchymal Hemorrhage. The cohort comprised of 128 patients, 88 lobar, and 40 deep Intraparenchymal Hemorrhage. Electrographic seizures occurred in 17% of lobar and 5% of deep Intraparenchymal Hemorrhage (p = 0.09). Hyperexcitable patterns were more frequent in the lobar group (44.3% vs 17.5%; p = 0.005). In multivariable analyses in the lobar group, lateralized rhythmic delta activity predicted electrographic seizures (odds ratio, 6.24; CI, 1.49-26.08; p = 0.012); insular involvement predicted hyperexcitable patterns (odds ratio, 4.88; CI, 1.36-17.57; p = 0.015); coma, temporal lobe involvement, Intraparenchymal Hemorrhage volume, and electrographic seizures predicted poor outcome. Thalamic involvement did not affect electrographic seizures or hyperexcitable patterns in either group. Electrographic seizures are frequent in lobar Intraparenchymal Hemorrhage, occurring in one in six monitored patients, as opposed to only 5% in isolated deep Intraparenchymal Hemorrhage not extending to cortex/insula, subarachnoid, or subdural spaces. Patients with lobar Intraparenchymal Hemorrhage and lateralized rhythmic delta activity were six times as likely to have electrographic seizures, which were associated with 5.47 higher odds of a poor outcome. Coma, temporal lobe involvement, hematoma volume, and electrographic seizures predicted poor outcome in lobar Intraparenchymal Hemorrhage.
-
deep versus lobar Intraparenchymal Hemorrhage seizures hyperexcitable patterns and clinical outcomes
Critical Care Medicine, 2020Co-Authors: Zubeda Sheikh, Christoph Stretz, Carolina B. Maciel, Monica B. Dhakar, Hailey Orgass, Ognen A. C. Petroff, Lawrence J. Hirsch, Emily J. GilmoreAbstract:OBJECTIVES To compare electrographic seizures, hyperexcitable patterns, and clinical outcomes in lobar and deep Intraparenchymal Hemorrhage. Additionally, to characterize electrographic seizure and hyperexcitable pattern predictors in each group and determine seizure risk with thalamic involvement. DESIGN Retrospective cohort study. SETTING Tertiary academic medical center. PATIENTS Consecutive adult patients with nontraumatic Intraparenchymal Hemorrhage undergoing continuous electroencephalography at our center between January 2013 and December 2016. INTERVENTIONS Not applicable. MEASUREMENTS AND MAIN RESULTS Based on head CT closest to the initial continuous electroencephalography session, we classified Intraparenchymal Hemorrhage as isolated deep (no insular, subarachnoid, subdural extension) or lobar. Hyperexcitable patterns included the following: periodic discharges, spike-wave complexes, any rhythmic delta other than generalized. We used Fisher exact test for categorical and Mann-Whitney U test for continuous variables. Multivariable regression identified predictors of electrographic seizures, hyperexcitable patterns, and poor outcomes (score of 1-2 on Glasgow Outcome Scale) in lobar Intraparenchymal Hemorrhage. The cohort comprised of 128 patients, 88 lobar, and 40 deep Intraparenchymal Hemorrhage. Electrographic seizures occurred in 17% of lobar and 5% of deep Intraparenchymal Hemorrhage (p = 0.09). Hyperexcitable patterns were more frequent in the lobar group (44.3% vs 17.5%; p = 0.005). In multivariable analyses in the lobar group, lateralized rhythmic delta activity predicted electrographic seizures (odds ratio, 6.24; CI, 1.49-26.08; p = 0.012); insular involvement predicted hyperexcitable patterns (odds ratio, 4.88; CI, 1.36-17.57; p = 0.015); coma, temporal lobe involvement, Intraparenchymal Hemorrhage volume, and electrographic seizures predicted poor outcome. Thalamic involvement did not affect electrographic seizures or hyperexcitable patterns in either group. CONCLUSIONS Electrographic seizures are frequent in lobar Intraparenchymal Hemorrhage, occurring in one in six monitored patients, as opposed to only 5% in isolated deep Intraparenchymal Hemorrhage not extending to cortex/insula, subarachnoid, or subdural spaces. Patients with lobar Intraparenchymal Hemorrhage and lateralized rhythmic delta activity were six times as likely to have electrographic seizures, which were associated with 5.47 higher odds of a poor outcome. Coma, temporal lobe involvement, hematoma volume, and electrographic seizures predicted poor outcome in lobar Intraparenchymal Hemorrhage.
-
f80 seizures and hyperexcitable eeg patterns in spontaneous deep Intraparenchymal Hemorrhage
Clinical Neurophysiology, 2018Co-Authors: Zubeda Sheikh, Christoph Stretz, Carolina B. Maciel, Monica B. Dhakar, Lawrence J. Hirsch, Emily J. GilmoreAbstract:Introduction The incidence of electrographic seizures after non-traumatic Intraparenchymal Hemorrhage (IPH) ranges from 1.7% to 31%. It is unclear if the risk of seizures or hyperexcitable patterns (HEPs: any rhythmic delta activity except generalized, any periodic discharges, or any spike-wave pattern, using ACNS criteria) for deep IPH is similar to lobar, subarachnoid and subdural Hemorrhages. We hypothesized that the incidence of seizures or hyperexcitable patterns (SZ or HEPs) in deep IPH is lower than reported, but thalamic involvement may confer higher risk due to its role in physiologic and pathologic rhythmic activity, such as sleep spindles and generalized spike wave discharges. Methods On retrospective review, 45 patients had deep IPH (defined as IPH not involving cortex/juxtacortical regions other than the insula (analyzed separately), with or without intraventricular Hemorrhage IVH) and underwent continuous EEG (cEEG) between 1/2013 and 12/2016. Patients with involvement of cortex, subarachnoid or subdural areas were excluded. Age, sex, prior history of epilepsy, clinical seizure at ictus, anti-seizure drugs (ASDs), sedative infusions during EEG and surgical interventions such as ventriculostomy (EVD) or decompressive hemicraniectomy (DHC) were reviewed. The cEEG closest to admission was reviewed for seizures, HEPs, and generalized rhythmic delta activity (GRDA). The head CT in closest proximity to the index cEEG was reviewed for hematoma volume, thalamic involvement and insular involvement. Results Two of 45 patients had SZ, 7/45 had HEPs, 1/45 had both and a total of 8/45 had SZ or HEPs. Of the HEPs , LRDA was seen in 4/8, LPDs in 2/8, both LPDs and LRDA in 1/8. Of those with the lateralized HEPs, 4/7 were contralateral to IPH, 1/7 (14.2%) were bilateral and 2/7 were ipsilateral. Of the 5/7 with HEPs contralateral to the IPH, 2 had an EVD ipsilateral to the HEPs. Patients with SZ or HEPs had significantly higher hematoma volume compared to patients who did not have SZ or HEPs (32.7 ± 19.4 vs 15.4 ± 17.7, p = 0.02). Patients who underwent surgery (DHC/EVD or both) had higher incidence of HEPs or SZ compared to those who did not (7/23, 30.4% vs 1/22, 4.5%, p = 0.047). DHC was associated with significantly higher risk of SZ or HEPs (4/4, 100% vs 4/41, 9.8%, p Conclusion Risk of SZ or HEPs with deep IPH ± IVH was 17.7% and correlated with mean hematoma volume and DHC. The, risk in the absence of a surgical intervention was low (1/22, 4.5%, vs 7/23, 30.4% p = 0.047). Thalamic involvement did not correlate with SZ or HEPs in this small cohort of patients with deep IPH.