Top

Published in:

01-04-2011 | Original Article

Risk Factors and Outcome of Seizures After Chronic Subdural Hematoma

Authors: Yu-Hua Huang, Tzu-Ming Yang, Yu-Jun Lin, Nai-Wen Tsai, Wei-Che Lin, Hung-Chen Wang, Wen-Neng Chang, Cheng-Hsien Lu

Published in: Neurocritical Care | Issue 2/2011

Abstract

Background

Seizures are important neurologic complications of chronic subdural hematoma (CSDH). A better understanding of risk factors of seizures following CSDH is needed to identify the patient who will require treatment.

Methods

This one-year retrospective study enrolled 100 adult CSDH patients. Baseline prognostic variables were analyzed by Cox’s proportional hazards model after a minimum of 18 months of follow-up.

Results

Seizures occurred in 11 CSDH patients, including acute symptomatic seizures in 6.0% (6/100) and unprovoked seizures in 5.0% (5/100). None progressed to status epilepticus during hospitalization. After a minimum of 18 months of follow-up, the mean Glasgow Outcome Scores (GOSs) were 4.1 ± 1.4 and 4.7 ± 0.7 for patients with and without seizures, respectively. Cox’s proportional hazards model showed that only the mean GCS on admission (P = 0.004, OR = 0.78, 95% CI = 0.67–0.93) was independently associated with seizures, and a decrease of one mean GCS increased the seizure rate by 21.6%.

Conclusion

Lower mean GCS on admission is independently predictive of seizures, most of which occur within the first three months after CSDH.

Mori K, Maeda M. Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo). 2001;41:371–381.CrossRef

Luxon LM, Harrison MJ. Chronic subdural haematoma. Q J Med. 1979;48:43–53.PubMed

Ohno K, Maehara T, Ichimura K, Suzuki R, Hirakawa K, Monma S. Low incidence of seizures in patients with chronic subdural haematoma. J Neurol Neurosurg Psychiatry. 1993;56:1231–3.PubMedCrossRef

Grisoli F, Graziani N, Peragut JC, Vincentelli F, Fabrizi AP, Caruso G, et al. Peri-operative lumbar injection of Ringer’s lactate solution in chronic subdural hematomas: a series of 100 cases. Neurosurgery. 1988;623:616–21.CrossRef

Hirakawa K, Hashizume K, Fuchinoue T, Takahashi H, Nomura K. Statistical analysis of chronic subdural hematoma in 309 adult cases. Neurol Med Chir (Tokyo). 1972;12:71–83.CrossRef

Sabo RA, Hanigan WC, Aldag JC. Chronic subdural hematomas and seizures: the role of prophylactic anti-convulsive medication. Surg Neurol. 1995;43:579–82.PubMedCrossRef

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

Scotti G, Terbrugge K, Melançon D, Bélanger G. Evaluation of the age of subdural hematomas by computerized tomography. J Neurosurg. 1977;47:311–5.PubMedCrossRef

Commission on the Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 1981;22:489–501.

10.

Bladin CF, Alexandrov AV, Bellavance A, Bornstein N, Chambers B, Coté R, et al. Seizures after stroke: a prospective multi-center study. Arch Neurol. 2000;57:1617–22.PubMedCrossRef

11.

Yang TM, Lin WC, Chang WN, Ho JT, Wang HC, Tsai NW, et al. Predictors and outcome of seizures after spontaneous intra-cerebral hemorrhage. J Neurosurg. 2009;111:87–93.PubMedCrossRef

12.

Amirjamshidi A, Eftekhar B, Abouzari M, Rashidi A. The relationship between Glasgow coma/outcome scores and abnormal CT scan findings in chronic subdural hematoma. Clin Neurol Neurosurg. 2007;109:152–7.PubMedCrossRef

13.

Oishi M, Toyama M, Tamatani S, Kitazawa T, Saito M. Clinical factors of recurrent chronic subdural hematoma. Neurol Med Chir (Tokyo). 2001;41:382–6.CrossRef

14.

Nakaguchi H, Tanishima T, Yoshimasu N. Factors in the natural history of chronic subdural hematomas that influence their post-operative recurrence. J Neurosurg. 2001;95:256–62.PubMedCrossRef

15.

Markwalder TM, Steinsiepe KF, Rohner M, Reichenbach W, Markwalder H. The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage. J Neurosurg. 1981;55:390–6.PubMedCrossRef

16.

Engel J Jr, Van Ness PC, Rasmussen TB. Outcome with respect to epileptic seizures. In: Engel Jr J, editor. Surgical treatment of the epilepsies. 2nd ed. New York: Raven Press; 1993. p. 609–21.

17.

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

18.

Markwalder TM, Reulen HJ. Influence of neo-membranous organization, cortical expansion and subdural pressure on the post-operative course of chronic subdural hematoma: an analysis of 201 cases. Acta Neurochir (Wien). 1986;79:100–6.CrossRef

19.

Kotwica Z, Brzezinski J. Late results of surgical treatment of unilateral chronic subdural hematomas. Pol Tyg Lek. 1988;43:737–8.PubMed

20.

Chen CW, Chio CC. Early post-operative seizures after burr-hole drainage for chronic subdural hematoma: correlation with brain CT findings. J Clin Neurosci. 2004;11:706–9.PubMedCrossRef

21.

Kao M. Sedimentation level in chronic subdural hematoma visible on computerized tomography. J Neurosurg. 1983;58:246–51.PubMedCrossRef

22.

Broderson P, Gjerris F. Regional cerebral blood flow in patients with chronic subdural hematomas. Acta Neurol Scand. 1975;51:233–9.CrossRef

Title: Risk Factors and Outcome of Seizures After Chronic Subdural Hematoma
Authors: Yu-Hua Huang
Tzu-Ming Yang
Yu-Jun Lin
Nai-Wen Tsai
Wei-Che Lin
Hung-Chen Wang
Wen-Neng Chang
Cheng-Hsien Lu
Publication date: 01-04-2011
Publisher: Humana Press Inc
Published in: Neurocritical Care / Issue 2/2011
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-011-9509-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk Factors and Outcome of Seizures After Chronic Subdural Hematoma

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2011

Intracerebral Hemorrhage Specific Intensity of Care Quality Metrics

Hospital Mortality of Patients with Severe Traumatic Brain Injury is Associated with Serum PTX3 Levels

Comparison of Hypertonic Saline and Mannitol on Whole Blood Coagulation In Vitro Assessed by Thromboelastometry

Electrolyte Orders in the Neuroscience Intensive Care Unit: Worth the Value or Waste?

Unsecured Intracranial Aneurysms and Induced Hypertension in Cerebral Vasospasm: Is Induced Hypertension Safe?

Subarachnoid Hemorrhage: The First 24 hours. A Surgeon’s Perspective