Abstract Details

Title Clinical and Radiologic Correlates of Non-Metabolic Triphasic Waves and Epileptiform Activity in Primary Subarachnoid Hemorrhage

Topic Clinical Neurophysiology

Presentation(s) P02 - (-)

Poster/Presentation
Number 237

Objective

Background BACKGROUND: EEG is a commonly used diagnostic tool in patients with SAH.We describe specific EEG patterns in SAH patients with clinical and radiologic correlation.

Design/Methods DESIGN/METHODS: Patients with primary SAH admitted to two academic institutions between July 2009 and April 2012 were identified. Records were reviewed to identify intraventricular hemorrhage (IVH), intracerebral hemorrhagic extension(ICH), occurrence of delayed cerebral ischemia(DCI) and length of stay(LOS). EEG reports were reviewed and classified as: arrhythmic continuous slow activity(aCS), rhythmic and periodic slow activity of triphasic morphology(TW), epileptiform activity(EA), and background suppression(SUP).Patients with metabolic causes for TW were excluded.

Results RESULTS: Of 154 patients, 49 had EEG monitoring. Thirteen (26.5%) exhibited non-metabolic TW, 16 (32.7%) had EA, 18 (36.7%) had aCS, 1 patient had SUP and 1 had a normal EEG. EA was associated with DCI (56.3%) as compared to non-epileptiform patterns (31.7%; p = 0.04). Furthermore, EA was more common in patients with ICH without statistical significance (31.3% vs.18.2%;p=0.2). The presence of TW was associated with IVH as compared to other patterns (69.2% vs.41.7%;p=0.04) and IVH was more likely to be restricted to lateral ventricles in this group (80% vs. 46.7%; p=0.05). In patients with with IVH, the mean LOS is patients with TW was 42 ± 28.8 days vs. 19 ± 11.6 days (p=0.02).

Conclusions CONCLUSIONS: In patients with SAH, the presence of IVH within the lateral ventricles was associated with non-metabolic TW. This pattern has previously been scantly reported in the literature with diencephalic and brainstem lesions. The presence of TW in patients with IVH significantly increased LOS. The presence of epileptiform activity was associated with DCI and more likely to be seen in ICH.

Authors/Disclosures
Wazim Mohamed, MD (Detroit Medical Center/Wayne State University) PRESENTER	Dr. Mohamed has nothing to disclose.
	No disclosure on file
Tyson Burghardt, MD (Michigan State University)	No disclosure on file
	No disclosure on file
Aashit K. Shah, MD, FAAN (Carilion Clinic)	Dr. Shah has stock in Abbot, Abbivie, Gilead, Johnson and Johnson, Pfizer. The institution of Dr. Shah has received research support from Xenon Pharma.
Maysaa M. Basha, MD, FAAN (Wayne State University, Detroit Medical Center)	Dr. Basha has nothing to disclose.

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