Outcomes and predictors of seizure recurrence in post-stroke epilepsy, a retrospective hospital-based study.

BACKGROUND: The occurrence of seizures following a stroke is a well-recognized complication associated with a significant increase in morbidity and mortality. Despite the numerous studies examining outcomes and risk factors related to post-stroke seizures (PSS), there remains a lack of clarity regarding the clinical characteristics, treatment, and PSS recurrence (PSSR) rates in patients experiencing their initial episode of PSS. PURPOSE: This study aimed to determine the risk factors for developing recurrent seizures after first PSS and their effects on functional outcomes and mortality. METHODS: All patients underwent an electroencephalography (EEG) and were monitored for a minimum of 24 months following the first PSS. The primary endpoint was the recurrence of seizures. Predictive factors for PSSR were determined by using the Cox-proportional hazards model, and the cumulative latency of recurrence at 90, 180, 360, and 720 days was estimated using Kaplan-Meier analysis. RESULTS: Seizure recurred in 36.8% (39/106). Significant association of PSSR was noted with female gender, use of older anti-seizure medications (ASMs) (p<0.001), EEG findings as focal slow wave activity (p<0.001), Ictal epileptiform abnormalities (p=0.015), status epilepticus (p=0.015), and with severe disability (p=0.008). However, multivariate cox-proportional hazards model showed significant association of female gender (HR=3.28; 95% CI: 1.42-7.58; p=0.006). Hazard ratio (HR) was increased with older ASMs use, focal aware seizure types, Ictal EAs, and periodic discharges on EEG; though, statistically significant. CONCLUSION: Factors such as the type of ASMs, EEG findings, and seizure type were significantly linked to PSSR. Female gender was the only independent predictor established. Additionally, significant functional decline was reported with recurrence.

Clinical Implications of Various Electroencephalographic Patterns in Post-Stroke Seizures. The Utility of Routine Electroencephalogram.

Objective: Post-stroke seizures (PSS) are one of the major stroke-related complications. Early therapeutic interventions are critical therefore using electroencephalography (EEG) as a predictive tool for future recurrence may be helpful. We aimed to assess frequencies of different EEG patterns in patients with PSS and their association with seizure recurrence and functional outcomes. Methods: All patients admitted with PSS were included and underwent interictal EEG recording during their admission and monitored for seizure recurrence for 24 months. Results: PSS was reported in 106 patients. Generalized slow wave activity (GSWA) was the most frequent EEG pattern observed (n = 62, 58.5%), followed by Focal sharp wave discharges (FSWDs) (n = 57, 55.8%), focal slow wave activity (FSWA) (n = 56, 52.8%), periodic discharges (PDs) (n = 13, 12.3%), and ictal epileptiform abnormalities (n = 6, 5.7%). FSWA and ictal EAs were positively associated with seizure recurrence (p < .001 and p = .015 respectively) and it remained significant even after adjusting for age, sex, stroke severity, stroke subtype, or use of anti-seizure medications (ASMs). Other positive associations were status epilepticus (SE) (p = .015), and use of older ASM (p < .001). FSWA and GSWA in EEG were positively associated with severe functional disability (p = .055, p = .015 respectively). Other associations were; Diabetes Mellitus (p = .034), Chronic Kidney Disease (p = .002), use of older ASMs (p = .037), presence of late PSS (p = .021), and those with Ischemic stroke (p = .010). Conclusions: Recognition and documentation of PSS-related EEG characteristics are important, as certain EEG patterns may help to identify the patients who are at risk of developing recurrence or worse functional outcomes.

Spontaneous Intracerebral Hemorrhage among Hypertensive Patients in Saudi Arabia: Study from a Tertiary Center.

Background: Spontaneous intracerebral hemorrhage (ICH) is the second most common cause of stroke, yet there is paucity of evidence regarding the same from Saudi Arabia. Objectives: To describe the clinical characteristics of spontaneous ICH as well as determine the role of gender in ICH and the usefulness of the ICH scoring system for assessing the 30-day mortality risk. Patients and Methods: This retrospective study included all patients diagnosed with spontaneous ICH at King Fahd Hospital of the University, Al Khobar, Saudi Arabia, between April 01, 2014, and April 30, 2019. Data regarding clinical characteristics, risk factors, and radiological features of ICH were extracted. Further, gender-related differences were determined. The 30-day mortality rates were assessed using the ICH score. Results: A total of 148 patients were diagnosed with spontaneous ICH during the study period. Of these, 100 (67.5%) were male and the overall mean age was 60 ± 15 years. About 48% of the male patients were aged ≤50 years compared to 27% of the female patients (P = 0.016). Impaired renal function (35.8%) and diabetes (33.7%) were the most frequent risk factors; hemiparesis (51%) and language impairment (42%) were the most common presenting symptoms; and basal ganglia (40.5%) was the most common location. The 30-day mortality rate was 30%. The mean ICH score at presentation was significantly high in those who died within 30 days of presentation (2.2 ± 1.6; P < 0.0001). Each increase in the ICH score was associated with an increase in mortality rate (P < 0.001 for trend). Conclusion: Patients with spontaneous ICH were found to have a high prevalence of vascular risk factors and mortality rate. The ICH scoring system was shown to be a useful clinical tool for evaluating the 30-day mortality risk.

Cerebral Venous Sinus Thrombosis in Inflammatory Bowel Disease: A Review of Published Case Reports.

Cerebral venous sinus thrombosis (CVST) is a rare extraintestinal manifestation of inflammatory bowel disease (IBD), and the risk of poor clinical outcomes remains high in patients with delayed CVST diagnoses. This study aimed to highlight the need to recognize the critical nature of CVST complications in IBD and the challenges associated with managing concurrent conditions. We retrospectively reviewed previously reported cases of CVST in patients with IBD by searching the PubMed, Web of Science, and Google Scholar databases for articles published between 2013 and 2020. Our search identified 35 cases of IBD complicated by CVST. The mean patient age was 24.6 years (range, 31 months-47 years; men > women, ratio, 1.18:1). CVST was 3.8 times more common among patients with ulcerative colitis than among those with Crohn's disease. Active IBD was reported in 91.4% of patients. The mean interval between IBD diagnosis and CVST occurrence was 3 years (range, 2 days-16 years). Headache was the most frequently reported symptom (85.7%), and involvement of multiple sinuses was reported in almost two-thirds of the patients. Corticosteroid therapy at the time of the CVST event was the most common prothrombotic risk factor, present in 57.14% of patients. The overall recovery rate after treatment was 77.14%; whereas the bleeding complication rate was 10%. This review provides essential information that can aid clinicians in making earlier diagnoses and promotes preventive strategies for CVST in patients with IBD. Given that CVST management can be challenging in these patients, a multidisciplinary approach is warranted.

Stroke literacy in the population of the Eastern Province of Saudi Arabia; immediate steps are essential to bridge the gap.

BACKGROUND AND PURPOSE: Stroke is a medical emergency that demands early recognition for time sensitive acute management. Knowledge about stroke in public has not been found satisfactory in most of the studies worldwide. Studies describing the awareness of public about recognition of stroke and its treatment from Saudi Arabia (SA) are deficient. This study aimed to assess the knowledge of general population living in the Eastern Province of SA about stroke in relation to recognition of warning signs, risk factors and available acute treatment. METHODS: A prospective, cross sectional study was conducted using a structured questionnaire distributed through an electronic web site over a period of six months. The data was analyzed with SPSS version 22.0. RESULTS: Among a total of 1,213 respondents, 62.4% were women. Three fourth identified the affected organ correctly. Psychological stress was the most commonly identified risk factor (73.5%) followed by hypertension (63.8%). More than half of the respondents (58.5%) were not aware of diabetes mellitus as a risk factor for stroke. Speech difficulty was the most commonly identified stroke warning sign (64.4%) followed by focal weakness (62.4%). More than half (59.9%) did not recognize facial asymmetry as stroke warning sign. Nearly three fourth of the participants were unaware of t-PA (73.7%) and nearest available health care center for acute stroke management (74.9%). CONCLUSION: Our survey found the stroke literacy in the population of the Eastern Province of SA as non- satisfactory and highlights the importance of taking immediate measure such as mass media campaign and hospital based activities to improve it.

Etiologic and Clinical Features of Cerebral Venous Sinus Thrombosis in Saudi Arabia.

OBJECTIVE: Our study aims to evaluate the etiologic and clinical features of cerebral venous sinus thrombosis (CVST) in Saudi Arabia, and secondarily whether gender plays a role in CVST. MATERIALS AND METHODS: Data were collected retrospectively from the stroke registry during the period from January 2008 to April 2018, and the patients with the diagnosis of CVST were identified, and data were analyzed for any gender-specific differences in clinical presentation and etiology of cerebral venous thrombosis. RESULTS: There were 15 females while 11 males with a female:male ratio of 1.4:1. The mean age was 29.4± standard deviation 8.9 with the age range of 15-49. Headache was the most common and usually the first presenting symptoms present in 65% followed by hemiparesis and cranial nerve palsies. The first neurological examination was normal in 9/26 (34.6%) of the patients, while the common abnormality was cranial nerve palsies. Infections and trauma played an important part in risk factor analysis of our patient after the pregnancy- and hormone-related conditions. Some significant differences between the clinical presentation and risk factors among males and females were noted as age at presentation was higher in females while trauma and infections were common in male patients, although the involvement of the sinuses and response to treatment did not prove to be statistically significant. CONCLUSION: The results of this study were similar to the available literature with few differences. The relatively higher proportion of males in our study can be explained partly with more cases of traumatic CVST. Some important differences were noted between the risk factors and clinical presentation among genders. Large-scale prospective studies are needed to further clarify these differences.