Continuous EEG monitoring in spontaneous intracerebral hemorrhage

Aim: to study the frequency of clinical and electrical seizure activity among patients with acute intracerebral hemorrhage (ICH). Methods: sixty seven patients with acute ICH who was admitted to King Abdul-Aziz Hospital and Oncology Center and to Saudi German Hospital, Jeddah, Saudi Arabia during one year duration were included. Diagnosis of ICH was based on computed tomography (CT) scan; patients were either admitted to ICU or to the ward; full history and clinical data were obtained; follow-up CT brain was done to all patients 48 hours and by the end of the first week of admission; site, size and distance from the surface of ICH as well as midline shift were measured; continuous electroencephalographic recording (cEEG) was done within the day of admission and lasted for 2-3 days thereafter; outcome was measured using Glasgow Outcome Scale (GOS). Results: hypertension was the most common risk factor for ICH (in 55.2%), followed by anticoagulant usage (7.5%); seizures (either clinical or electrographic) occurred in 17 patients (25.4%), 76.5% of them were electrographic seizures; ICH proximity to the surface, its volume, midline shift and increase in the size of ICH in follow up CT were risk factors for seizure occurrence; those with seizure disorders showed worse GOS measure. Conclusion: seizures occur in high percentage of patients with ICH and most of them is electrographic in nature, there occurrence depends on ICH volume or its expansion and midline shift, and they adversely affect the prognosis of the patients.