scholarly journals One Size Does Not Fit All: Risk Stratification in Seizure Prophylaxis

2021 ◽  
pp. 153575972110561
Author(s):  
Peter Widdess-Walsh
Keyword(s):  
Risk Stratification ◽  
Seizure Prophylaxis

Cocaine use as an independent predictor of seizures after aneurysmal subarachnoid hemorrhage

2016 ◽  
Vol 124 (3) ◽  
pp. 730-735 ◽  
Author(s):  
Tiffany R. Chang ◽  
Robert G. Kowalski ◽  
J. Ricardo Carhuapoma ◽  
Rafael J. Tamargo ◽  
Neeraj S. Naval
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Risk Stratification ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Clinical Grade ◽  
Surgical Clipping ◽  
Cocaine Use ◽  
Seizure Prophylaxis ◽  
Cocaine Users ◽  
Mca Aneurysm ◽  
The Impact

OBJECT Seizures are relatively common after aneurysmal subarachnoid hemorrhage (aSAH). Seizure prophylaxis is controversial and is often based on risk stratification; middle cerebral artery (MCA) aneurysms, associated intracerebral hemorrhage (ICH), poor neurological grade, increased clot thickness, and cerebral infarction are considered highest risk for seizures. The purpose of this study was to evaluate the impact of recent cocaine use on seizure incidence following aSAH. METHODS Prospectively collected data from aSAH patients admitted to 2 institutional neuroscience critical care units between 1991 and 2009 were reviewed. The authors analyzed factors that potentially affected the incidence of seizures, including patient demographic characteristics, poor clinical grade (Hunt and Hess Grade IV or V), medical comorbidities, associated ICH, intraventricular hemorrhage (IVH), hydrocephalus, aneurysm location, surgical clipping and cocaine use. They further studied the impact of these factors on “early” and “late” seizures (defined, respectively, as occurring before and after clipping/coiling). RESULTS Of 1134 aSAH patients studied, 182 (16%) had seizures; 81 patients (7.1%) had early and 127 (11.2%) late seizures, with 26 having both. The seizure rate was significantly higher in cocaine users (37 [26%] of 142 patients) than in non-cocaine users (151 [15.2%] of 992 patients, p = 0.001). Eighteen cocaine-positive patients (12.7%) had early seizures compared with 6.6% of cocaine-negative patients (p = 0.003); 27 cocaine users (19%) had late seizures compared with 10.5% non-cocaine users (p = 0.001). Factors that showed a significant association with increased risk for seizure (early or late) on univariate analysis included younger age (< 40 years) (p = 0.009), poor clinical grade (p = 0.029), associated ICH (p = 0.007), and MCA aneurysm location (p < 0.001); surgical clipping was associated with late seizures (p = 0.004). Following multivariate analysis, age < 40 years (OR 2.04, 95% CI 1.355–3.058, p = 0.001), poor clinical grade (OR 1.62, 95% CI 1.124–2.336, p = 0.01), ICH (OR 1.95, 95% CI 1.164–3.273, p = 0.011), MCA aneurysm location (OR 3.3, 95% CI 2.237–4.854, p < 0.001), and cocaine use (OR 2.06, 95% CI 1.330–3.175, p = 0.001) independently predicted seizures. CONCLUSIONS Cocaine use confers a higher seizure risk following aSAH and should be considered during risk stratification for seizure prophylaxis and close neuromonitoring.

Abstract #564 Advanced Ultrasound Application- Impact on Presurgical Risk Stratification of Thyroid Nodules

2019 ◽  
Vol 25 ◽  
pp. 287
Author(s):  
Andreea Borlea ◽  
Dana Stoian ◽  
Adrian Apostol ◽  
Mihnea Derban ◽  
Laura Cotoi ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Thyroid Nodules ◽  
Ultrasound Application
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