Abstracts

Rationale: Several acquired processes have been implicated as causes of temporal lobe seizures, however, little information is available on seizures caused by intracerebral hemorrhage (ICH). Here we wished to: (1) determine the risk of seizures in patients with spontaneous ICH in temporal lobe, and (2) describe clinical, radiographic and electroencephalographic (EEG) characteristics of these patients. Methods: We performed a retrospective analysis of the records of selected patients with spontaneous ICH in our Neurology Intensive Care Unit database. The relative risk for seizure development after ICH affecting the temporal lobe was compared to ICH in other areas of brain. Seizure semiology, EEG features and magnetic resonance imaging (MRI) in coronal planes were analyzed. Results: Out of 81 patients with ICH, 10 had temporal lobe ICH and 6 of them (60%) had new onset seizures during hospitalization. Analysis of our data indicated that ICH in temporal lobe was associated with a 10-fold higher risk for seizure compared to ICH in other sites, including occipital/parietal/frontal lobes, basal ganglia and thalamus (Odds Ratio 10.3; CI 2.4-43.8). In about 50% of the cases convulsive seizures presented within the first 24 hours of acute hemorrhage. In the other half cases, seizures developed at 1-3 weeks after the onset of ICH. The later subgroup of patients developed complex partial seizures without secondary generalization. Review of EEGs revealed focal temporal slowing in 50% and temporal sharps and spikes in 32% of the cases. In one case bifrontal spikes were present. Analysis of MRI images showed that the average distance of the hematoma from the hippocampal cortex was 9.4 mm. Conclusions: Our preliminary observations indicate that patients with spontaneous temporal lobe ICH in proximity of hippocampus have a higher risk for seizures compared to ICH in other sites. Seizures can present in complex partial form and may be overlooked. Continuous EEG monitoring and clinical follow up will lead to a better understanding and management of seizures in patients with spontaneous ICH.