Correlation Between Age, the Development of Seizures, the National Institutes of Health Stroke Scale, the Modified Rankin Scale, and Discharge Status in Patients With Acute Hemorrhagic Stroke

Noha Mahmoud Youssef; Mohamed Shabana Hussein; Thel Su Hlaing; Khant Nyi Zaya; Myat Khant Wai; Mohamad Salah Shurbahji; Ahmed Elsayed Nour; Nada Breika; Marwa Harb; Rowa Murtada Ali Suliman; Sithu Bala; Esraa Samir Saleh Awadalla; Mohamed Bassem Elmoursi Abdou; Ahmad Adel Abdelhameed Muhammad; Sarah Haitham A Al-Wardi; Mahmoud Ashraf Gaber Hani; Abdulmabod Omar

doi:10.7759/cureus.95052

Correlation Between Age, the Development of Seizures, the National Institutes of Health Stroke Scale, the Modified Rankin Scale, and Discharge Status in Patients With Acute Hemorrhagic Stroke

Cureus. 2025 Oct 21;17(10):e95052. doi: 10.7759/cureus.95052. eCollection 2025 Oct.

Authors

Noha Mahmoud Youssef¹, Mohamed Shabana Hussein², Thel Su Hlaing³, Khant Nyi Zaya⁴, Myat Khant Wai⁵, Mohamad Salah Shurbahji⁶, Ahmed Elsayed Nour⁷, Nada Breika⁸, Marwa Harb⁹, Rowa Murtada Ali Suliman¹⁰, Sithu Bala¹¹, Esraa Samir Saleh Awadalla², Mohamed Bassem Elmoursi Abdou¹², Ahmad Adel Abdelhameed Muhammad¹³, Sarah Haitham A Al-Wardi¹⁴, Mahmoud Ashraf Gaber Hani¹⁵, Abdulmabod Omar¹⁶

Affiliations

¹ Neurology Department, Qena University Hospitals, Qena, EGY.
² Neurology Department, Mansoura International Hospital, Mansoura, EGY.
³ Internal Medicine Department, Nevill Hall Hospital, Abergavenny, GBR.
⁴ Velindre Cancer Centre, NHS Wales, Cardiff, GBR.
⁵ Medicine Department, University Hospitals Plymouth NHS Trust, Plymouth, GBR.
⁶ Faculty of Medicine, Ain Shams University, Cairo, EGY.
⁷ Fulbourn Hospital, Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), Cambridge, GBR.
⁸ Peterborough City Hospital, North West Anglia NHS Foundation Trust (NWAFT), Peterborough, GBR.
⁹ General Practice, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR.
¹⁰ Older Person's Medicine, South Tees Hospitals NHS Foundation Trust, Middlesbrough, GBR.
¹¹ Medicine, Lister Hospital, East and North Hertfordshire Teaching NHS Trust, London, GBR.
¹² Emergency Medicine Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR.
¹³ Emergency Medicine and Critical Care Department, Dr. Hassan Ghazzawi Hospital, Jeddah, SAU.
¹⁴ Psychiatry Department, Cygnet Hospital Wyke, Bradford, GBR.
¹⁵ Neurology Department, University Hospital Southampton, Southampton, GBR.
¹⁶ Faculty of Medicine, Al-Azhar University, Cairo, EGY.

Abstract

Background Seizures are a common consequence of acute hemorrhagic stroke, which has a high morbidity and fatality rate. It is yet unknown how they relate to age, the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS), and discharge status. Methods We conducted a cross-sectional study of 75 patients (aged 16-92 years) with acute hemorrhagic stroke admitted to the Neuropsychiatry Department of Qena University Hospitals, a tertiary care center serving a large catchment area in Upper Egypt. Data were collected over six months, from September 2024 to February 2025. Neurological impairment was assessed using the NIHSS, and functional outcome was measured using the mRS at admission and discharge. Statistical comparisons included paired t-tests and Wilcoxon signed-rank tests. Associations between seizures, age, stroke severity, and outcomes were also analyzed. Results Seizures were not correlated with age. During hospitalization, a noteworthy mean improvement in NIHSS (+0.97; t = 10.70 and p < 0.0001; W = 21.50 and p < 0.0001) was noted, suggesting neurological recovery. On the other hand, mRS remained at a median 3 (t = -0.51 and p = 0.6113; W = 275 and p = 0.9173), indicating no discernible change. There was no discernible change in NIHSS or mRS among patients who were released on demand (n = 10). Ten out of the 12 in-hospital fatalities had seizures, and the majority had moderate-to-severe strokes (NIHSS ≥9; mRS ≥3). Patients with very severe strokes (NIHSS 16-17; mRS = 5) and no recovery experienced two non-seizure fatalities. Admission NIHSS (1-17) and mRS (1-5) showed a broad variety of stroke presentations and recovery trajectories. Conclusion The baseline of stroke severity was the best indicator of a bad prognosis in acute hemorrhagic stroke, and seizure incidence was not age-dependent. Significant neurological recovery was recorded by NIHSS, but short-term functional improvement was not reflected by mRS. These results indicate that seizures are more common in fatal cases but secondary to the total load of strokes, underscoring the prognostic significance of baseline severity.

Keywords: hemorrhagic stroke; intracerebral hemorrhage; mrs; nihss; prognosis; seizures.