Skip to main content

Advertisement

SpringerLink
Log in

Non-electrographic Seizures Due to Subdural Hematoma: A Case Series and Review of the Literature

  • Review Article
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Seizures due to subdural hematoma (SDH) are a common finding, typically diagnosed using electroencephalography (EEG). At times, aggressive management of seizures is necessary to improve neurologic recovery and outcomes. Here, we present three patients who had undergone emergent SDH evacuation and showed postoperative focal deficits without accompanying electrographic epileptiform activity. After infarction and recurrent hemorrhage were ruled out, seizures were suspected despite a negative EEG. Patients were treated aggressively with AEDs and eventually showed clinical improvement. Long-term monitoring with EEG revealed electrographic seizures in a delayed fashion. EEG recordings are an important tool for seizure detection, but should be used as an adjunct to, rather than a replacement for, the clinical examination in the acute setting. At times, aggressive treatment of suspected postoperative seizures is warranted despite lack of corresponding electrographic activity and can improve clinical outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Frontera JA, Egorova N, Moskowitz AJ. National trend in prevalence, cost, and discharge disposition after subdural hematoma from 1998–2007. Crit Care Med. 2011;39(7):1619–25.

    Article  PubMed  Google Scholar 

  2. Cole M, Spatz E. Seizures in chronic subdural hematoma. N Engl J Med. 1961;265:628–31.

    Article  CAS  PubMed  Google Scholar 

  3. Rubin G, Rappaport ZH. Epilepsy in chronic subdural haematoma. Acta Neurochir. 1993;123(1–2):39–42.

    Article  CAS  PubMed  Google Scholar 

  4. Rabinstein AA, Chung SY, Rudzinski LA, Lanzino G. Seizures after evacuation of subdural hematomas: incidence, risk factors, and functional impact. J Neurosurg. 2010;112(2):455–60.

    Article  PubMed  Google Scholar 

  5. Pollandt S, Ouyang B, Bleck TP, Busl KM. Seizures and epileptiform discharges in patients with acute subdural hematoma. J Clin Neurophysiol. 2017;34(1):55–60. https://doi.org/10.1097/WNP.0000000000000311.

  6. Radic JA, Chou SH, Du R, Lee JW. Levetiracetam versus phenytoin: a comparison of efficacy of seizure prophylaxis and adverse event risk following acute or subacute subdural hematoma diagnosis. Neurocrit Care. 2014;21(2):228–37.

    Article  CAS  PubMed  Google Scholar 

  7. Huang YH, Yang TM, Lin YJ, et al. Risk factors and outcome of seizures after chronic subdural hematoma. Neurocrit Care. 2011;14(2):253–9.

    Article  PubMed  Google Scholar 

  8. Rudzinski LA, Rabinstein AA, Chung SY, et al. Electroencephalographic findings in acute subdural hematoma. J Clin Neurophysiol Off Publ Am Electroencephalogr Soc. 2011;28(6):633–41.

    Google Scholar 

  9. Seifi A, Asadi-Pooya AA, Carr K, et al. The epidemiology, risk factors, and impact on hospital mortality of status epilepticus after subdural hematoma in the United States. SpringerPlus. 2014;3:332.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Yeh CC, Chen TL, Hu CJ, Chiu WT, Liao CC. Risk of epilepsy after traumatic brain injury: a retrospective population-based cohort study. J Neurol Neurosurg Psychiatry. 2013;84(4):441–5.

    Article  PubMed  Google Scholar 

  11. Englander J, Bushnik T, Duong TT, et al. Analyzing risk factors for late posttraumatic seizures: a prospective, multicenter investigation. Arch Phys Med Rehabil. 2003;84(3):365–73.

    Article  PubMed  Google Scholar 

  12. Won SY, Konczalla J, Dubinski D, et al. A systematic review of epileptic seizures in adults with subdural haematomas. Seizure. 2016;45:28–35.

    Article  PubMed  Google Scholar 

  13. Vespa PM, Miller C, McArthur D, et al. Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. Crit Care Med. 2007;35(12):2830–6.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Vespa PM, O’Phelan K, Shah M, et al. Acute seizures after intracerebral hemorrhage: a factor in progressive midline shift and outcome. Neurology. 2003;60(9):1441–6.

    Article  CAS  PubMed  Google Scholar 

  15. Shneker BF, Fountain NB. Assessment of acute morbidity and mortality in nonconvulsive status epilepticus. Neurology. 2003;61(8):1066–73.

    Article  PubMed  Google Scholar 

  16. Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology. 1996;47(1):83–9.

    Article  CAS  PubMed  Google Scholar 

  17. Gavvala J, Abend N, LaRoche S, et al. Continuous EEG monitoring: a survey of neurophysiologists and neurointensivists. Epilepsia. 2014;55(11):1864–71.

    Article  PubMed  Google Scholar 

  18. Sutter R. Are we prepared to detect subtle and nonconvulsive status epilepticus in critically ill patients? J Clin Neurophysiol Off Publ Am Electroencephalogr Soc. 2016;33(1):25–31.

    Google Scholar 

  19. Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004;62(10):1743–8.

    Article  CAS  PubMed  Google Scholar 

  20. Hashiguchi K, Morioka T, Yoshida F, et al. Correlation between scalp-recorded electroencephalographic and electrocorticographic activities during ictal period. Seizure. 2007;16(3):238–47.

    Article  PubMed  Google Scholar 

  21. Pacia SV, Ebersole JS. Intracranial EEG substrates of scalp ictal patterns from temporal lobe foci. Epilepsia. 1997;38(6):642–54.

    Article  CAS  PubMed  Google Scholar 

  22. Lieb JP, Walsh GO, Babb TL, Walter RD, Crandall PH. A comparison of EEG seizure patterns recorded with surface and depth electrodes in patients with temporal lobe epilepsy. Epilepsia. 1976;17(2):137–60.

    Article  CAS  PubMed  Google Scholar 

  23. Wennberg R, Arruda F, Quesney LF, Olivier A. Preeminence of extrahippocampal structures in the generation of mesial temporal seizures: evidence from human depth electrode recordings. Epilepsia. 2002;43(7):716–26.

    Article  PubMed  Google Scholar 

  24. Lam AD, Zepeda R, Cole AJ, Cash SS. Widespread changes in network activity allow non-invasive detection of mesial temporal lobe seizures. Brain J Neurol. 2016;139(Pt 10):2679–93.

    Article  Google Scholar 

  25. Bialasiewicz P, Nowak D. Obstructive sleep apnea syndrome and nocturnal epilepsy with tonic seizures. Epileptic Disord Int Epilepsy J Videotape. 2009;11(4):320–3.

    Google Scholar 

  26. Mendes A, Sampaio L. Brain magnetic resonance in status epilepticus: a focused review. Seizure. 2016;38:63–7.

    Article  PubMed  Google Scholar 

  27. Lansberg MG, O’Brien MW, Norbash AM, Moseley ME, Morrell M, Albers GW. MRI abnormalities associated with partial status epilepticus. Neurology. 1999;52(5):1021–7.

    Article  CAS  PubMed  Google Scholar 

  28. Hong KS, Cho YJ, Lee SK, Jeong SW, Kim WK, Oh EJ. Diffusion changes suggesting predominant vasogenic oedema during partial status epilepticus. Seizure. 2004;13(5):317–21.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA, 02115, USA

    Joseph Driver, Aislyn C. DiRisio & William B. Gormley

  2. Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA

    Heidi Mitchell

  3. Department of Neurology, Massachusetts General Hospital and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Zachary D. Threlkeld

Authors
  1. Joseph Driver
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aislyn C. DiRisio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heidi Mitchell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zachary D. Threlkeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. William B. Gormley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William B. Gormley.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Driver, J., DiRisio, A.C., Mitchell, H. et al. Non-electrographic Seizures Due to Subdural Hematoma: A Case Series and Review of the Literature. Neurocrit Care 30, 16–21 (2019). https://doi.org/10.1007/s12028-018-0503-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-018-0503-2

Keywords

Search

Navigation