Tonic-clonic activity at subarachnoid hemorrhage onset: impact on complications and outcome.
<h4>Objective</h4>Tonic-clonic activity (TCA) at onset complicates 3% to 21% of cases of subarachnoid hemorrhage (SAH). The impact of onset TCA on in-hospital complications, including seizures, remains unclear. One study associated onset TCA with poor clinical outcome at 6 weeks after SA...
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2013
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oai:doaj.org-article:0ef4463e4d09458c8c2defc4f08838902021-11-18T09:00:10ZTonic-clonic activity at subarachnoid hemorrhage onset: impact on complications and outcome.1932-620310.1371/journal.pone.0071405https://doaj.org/article/0ef4463e4d09458c8c2defc4f08838902013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23951155/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objective</h4>Tonic-clonic activity (TCA) at onset complicates 3% to 21% of cases of subarachnoid hemorrhage (SAH). The impact of onset TCA on in-hospital complications, including seizures, remains unclear. One study associated onset TCA with poor clinical outcome at 6 weeks after SAH, but to our knowledge no other studies have confirmed this relationship. This study aims to assess the impact of onset TCA on in-hospital complications, poor functional outcome, mortality, and epilepsy at 3 months.<h4>Methods</h4>Analysis of a prospective study cohort of 1479 SAH patients admitted to Columbia University Medical Center between 1996 and 2012. TCA within 6 hours of hemorrhage onset was identified based on accounts of emergency care providers or family witnesses.<h4>Results</h4>TCA at onset was described in 170 patients (11%). Patients with onset TCA were younger (P = 0.002), presented more often with poor clinical grade (55% vs. 26%, P<0.001) and had larger amounts of cisternal, intraventricular, and intracerebral blood than those without onset TCA (all, P<0.001). After adjusting for known confounders, onset TCA was significantly associated with in-hospital seizures (OR 3.80, 95%-CI: 2.43-5.96, P<0.001), in-hospital pneumonia (OR 1.56, 95%-CI: 1.06-2.31, p = 0.02), and delayed cerebral ischemia (OR 1.77, 95%-CI: 1.21-2.58, P = 0.003). At 3 months, however, onset TCA was not associated with poor functional outcome, mortality, and epilepsy after adjusting for age, admission clinical grade, and cisternal blood volume.<h4>Conclusions</h4>Onset TCA is not a rare event as it complicates 11% of cases of SAH. New and clinically relevant findings are the association of onset TCA with in-hospital seizures, pneumonia and delayed cerebral ischemia. Despite the increased risk of in-hospital complications, onset TCA is not associated with disability, mortality, and epilepsy at 3 months.Gian Marco De MarchisDeborah PuginHector LantiguaChristopher ZammitPrasanna TadiJ Michael SchmidtM Cristina FaloSachin AgarwalStephan A MayerJan ClaassenPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 8, p e71405 (2013) |
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Medicine R Science Q Gian Marco De Marchis Deborah Pugin Hector Lantigua Christopher Zammit Prasanna Tadi J Michael Schmidt M Cristina Falo Sachin Agarwal Stephan A Mayer Jan Claassen Tonic-clonic activity at subarachnoid hemorrhage onset: impact on complications and outcome. |
| description |
<h4>Objective</h4>Tonic-clonic activity (TCA) at onset complicates 3% to 21% of cases of subarachnoid hemorrhage (SAH). The impact of onset TCA on in-hospital complications, including seizures, remains unclear. One study associated onset TCA with poor clinical outcome at 6 weeks after SAH, but to our knowledge no other studies have confirmed this relationship. This study aims to assess the impact of onset TCA on in-hospital complications, poor functional outcome, mortality, and epilepsy at 3 months.<h4>Methods</h4>Analysis of a prospective study cohort of 1479 SAH patients admitted to Columbia University Medical Center between 1996 and 2012. TCA within 6 hours of hemorrhage onset was identified based on accounts of emergency care providers or family witnesses.<h4>Results</h4>TCA at onset was described in 170 patients (11%). Patients with onset TCA were younger (P = 0.002), presented more often with poor clinical grade (55% vs. 26%, P<0.001) and had larger amounts of cisternal, intraventricular, and intracerebral blood than those without onset TCA (all, P<0.001). After adjusting for known confounders, onset TCA was significantly associated with in-hospital seizures (OR 3.80, 95%-CI: 2.43-5.96, P<0.001), in-hospital pneumonia (OR 1.56, 95%-CI: 1.06-2.31, p = 0.02), and delayed cerebral ischemia (OR 1.77, 95%-CI: 1.21-2.58, P = 0.003). At 3 months, however, onset TCA was not associated with poor functional outcome, mortality, and epilepsy after adjusting for age, admission clinical grade, and cisternal blood volume.<h4>Conclusions</h4>Onset TCA is not a rare event as it complicates 11% of cases of SAH. New and clinically relevant findings are the association of onset TCA with in-hospital seizures, pneumonia and delayed cerebral ischemia. Despite the increased risk of in-hospital complications, onset TCA is not associated with disability, mortality, and epilepsy at 3 months. |
| format |
article |
| author |
Gian Marco De Marchis Deborah Pugin Hector Lantigua Christopher Zammit Prasanna Tadi J Michael Schmidt M Cristina Falo Sachin Agarwal Stephan A Mayer Jan Claassen |
| author_facet |
Gian Marco De Marchis Deborah Pugin Hector Lantigua Christopher Zammit Prasanna Tadi J Michael Schmidt M Cristina Falo Sachin Agarwal Stephan A Mayer Jan Claassen |
| author_sort |
Gian Marco De Marchis |
| title |
Tonic-clonic activity at subarachnoid hemorrhage onset: impact on complications and outcome. |
| title_short |
Tonic-clonic activity at subarachnoid hemorrhage onset: impact on complications and outcome. |
| title_full |
Tonic-clonic activity at subarachnoid hemorrhage onset: impact on complications and outcome. |
| title_fullStr |
Tonic-clonic activity at subarachnoid hemorrhage onset: impact on complications and outcome. |
| title_full_unstemmed |
Tonic-clonic activity at subarachnoid hemorrhage onset: impact on complications and outcome. |
| title_sort |
tonic-clonic activity at subarachnoid hemorrhage onset: impact on complications and outcome. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2013 |
| url |
https://doaj.org/article/0ef4463e4d09458c8c2defc4f0883890 |
| work_keys_str_mv |
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