Epileptiform abnormalities predict delayed cerebral ischemia in subarachnoid hemorrhage.
Epileptiform abnormalities predict delayed cerebral ischemia in subarachnoid hemorrhage.
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DOI：
10.1016/j.clinph.2017.01.016
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发表时间：
2017-06
期刊：
影响因子：
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通讯作者：
Westover MB
中科院分区：
文献类型：
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作者：
Kim JA;Rosenthal ES;Biswal S;Zafar S;Shenoy AV;O'Connor KL;Bechek SC;Valdery Moura J;Shafi MM;Patel AB;Cash SS;Westover MB
为了确定异常的神经活动，以癫痫样放电和节律性或周期性活动的形式，我们在这里称之为突发-间歇连续异常（IICAs），是否与延迟性脑缺血（DCI）有关。124例中重度蛛网膜下腔出血（SAH）患者的连续脑电图（cEEG）报告和病历回顾性分析我们确定了癫痫发作和iica的每日发生率。使用生存分析方法，我们估计了延迟性脑缺血（DCI）患者和非延迟性脑缺血（DCI）患者IICA发病时间的累积概率。我们的数据表明，iica的存在确实增加了发生DCI的风险，特别是当它们在SAH发作后几天开始时。我们发现，除了广泛性节律性delta活动外，所有类型的IICA在DCI患者中更常见。特别是，在住院后开始的iica与DCI风险增加相关。因此，iica代表了识别早期DCI风险增加患者的新标记。此外，iica可能在机制上促进DCI，因此代表了预防SAH后继发性脑损伤的干预的新潜在目标。这些发现表明iica可能是预测DCI发展风险较高的新标志物。
To identify whether abnormal neural activity, in the form of epileptiform discharges and rhythmic or periodic activity, which we term here ictal-interictal continuum abnormalities (IICAs), are associated with delayed cerebral ischemia (DCI). Retrospective analysis of continuous electroencephalography (cEEG) reports and medical records from 124 patients with moderate to severe grade subarachnoid hemorrhage (SAH). We identified daily occurrence of seizures and IICAs. Using survival analysis methods, we estimated the cumulative probability of IICA onset time for patients with and without delayed cerebral ischemia (DCI). Our data suggest the presence of IICAs indeed increases the risk of developing DCI, especially when they begin several days after the onset of SAH. We found that all IICA types except generalized rhythmic delta activity occur more commonly in patients who develop DCI. In particular, IICAs that begin later in hospitalization correlate with increased risk of DCI. Thus, IICAs represent a new marker for identifying early patients at increased risk for DCI. Moreover, IICAs might contribute mechanistically to DCI and therefore represent a new potential target for intervention to prevent secondary cerebral injury following SAH. These findings imply that IICAs may be a novel marker for predicting those at higher risk for DCI development.