Hyperemia in subarachnoid hemorrhage patients is associated with an increased risk of seizures

Ayham Alkhachroum, Murad Megjhani, Kalijah Terilli, Clio Rubinos, Jenna Ford, Brendan K. Wallace, David J. Roh, Sachin Agarwal, E. Sander Connolly, Amelia K. Boehme, Jan Claassen, Soojin Park*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


The association between impaired brain perfusion, cerebrovascular reactivity status and the risk of ictal events in patients with subarachnoid hemorrhage is unknown. We identified 13 subarachnoid hemorrhage (SAH) patients with seizures and 22 with ictal-interictal continuum (IIC), and compared multimodality physiological recordings to 38 similarly poor-grade SAH patients without ictal activity. We analyzed 10,179 cumulative minutes of seizure and 12,762 cumulative minutes of IIC. Cerebrovascular reactivity (PRx) was not different between subjects with seizures, IIC, or controls. Cerebral perfusion pressure (CPP) was higher in patients with seizures [99 ± 6.5, p =.005] and IIC [97 ± 8.5, p =.007] when compared to controls [89 ± 12.3]. DeltaCPP, defined as actual CPP minus optimal CPP (CPPopt), was also higher in the seizure group [8.3 ± 7.9, p =.0003] and IIC [8.1 ± 10.3, p =.0006] when compared to controls [−0.1 ± 5]. Time spent with supra-optimal CPP was higher in the seizure group [342 ± 213 min/day, p =.002] when compared to controls [154 ± 120 min/day]. In a temporal examination, a supra-optimal CPP preceded increased seizures and IIC in SAH patients, an hour before and continued to increase during the events [p <.0001].

Original languageEnglish (US)
Pages (from-to)1290-1299
Number of pages10
JournalJournal of Cerebral Blood Flow and Metabolism
Issue number6
StatePublished - Jun 1 2020


  • cerebral perfusion
  • electroencephalogram
  • ictal-interictal continuum
  • Seizures
  • subarachnoid hemorrhage

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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