Hirano Tsukasa, Enatsu Rei, Iihoshi Satoshi, Mikami Takeshi, Honma Toshimi, Ohnishi Hirofumi, Mikuni Nobuhiro
Department of Neurosurgery, Sapporo Medical University.
Department of Neurosurgery, Oji General Hospital.
Neurol Med Chir (Tokyo). 2019 Jan 15;59(1):27-32. doi: 10.2176/nmc.oa.2018-0125. Epub 2018 Dec 18.
Epilepsy after aneurysmal subarachnoid hemorrhage (post-SAH epilepsy) is a critical complication that influences clinical and social prognoses. However, the underlying mechanisms remain unclear. We investigated the relationship between hemosiderosis and the incidence of post-SAH epilepsy. About 50 patients with aneurysmal SAH who were admitted to Sapporo Medical University and Oji General Hospital between April 2010 and June 2016 were enrolled in this retrospective study. Hemosiderosis detected by T2*-weighted magnetic resonance imaging(MRI) and the incidence of post-SAH epilepsy were retrospectively analyzed. Post-SAH epilepsy was defined as an unprovoked seizures occurring more than 1 week after the onset of SAH. Six patients (12%) developed post-SAH epilepsy. In all patients, hemosiderosis in the cortex or cerebral parenchyma was detected by T2*-weighted MRI. Statistical analyses revealed that hemosiderosis and the co-existence of intracerebral hemorrhage (ICH) related with post-SAH epilepsy (Fisher's exact test, univariate exact logistic regression analysis: P < 0.05). Post-SAH epilepsy was predicted by hemosiderosis and the co-existence of ICH. The present results suggest that hemosiderin is the principal cause of post-SAH epilepsy and may be a predictor of this critical complication.
动脉瘤性蛛网膜下腔出血后癫痫（SAH后癫痫）是一种影响临床和社会预后的严重并发症。然而，其潜在机制仍不清楚。我们研究了含铁血黄素沉着症与SAH后癫痫发病率之间的关系。本回顾性研究纳入了2010年4月至2016年6月期间入住札幌医科大学和尾寺综合医院的约50例动脉瘤性SAH患者。对通过T2加权磁共振成像（MRI）检测到的含铁血黄素沉着症和SAH后癫痫的发病率进行了回顾性分析。SAH后癫痫定义为SAH发病1周后出现的无诱因发作。6例患者（12%）发生了SAH后癫痫。在所有患者中，通过T2加权MRI检测到皮质或脑实质内存在含铁血黄素沉着症。统计分析显示，含铁血黄素沉着症和脑内出血（ICH）的并存与SAH后癫痫相关（Fisher精确检验，单变量精确逻辑回归分析：P<0.05）。含铁血黄素沉着症和ICH的并存可预测SAH后癫痫。目前的结果表明，含铁血黄素是SAH后癫痫的主要原因，可能是这种严重并发症的一个预测指标。
