J Korean Neurotraumatol Soc.  2010 Dec;6(2):154-157. 10.13004/jknts.2010.6.2.154.

Status Epilepticus Caused by Small Amount Subacute to Chronic Subdural Hematoma: Case Report and Review of Literatures

• Seuk JW
• Chun HJ
• Yi HJ

• KMID: 2106803
• DOI: http://doi.org/10.13004/jknts.2010.6.2.154

Abstract

A 62-year-old man was admitted for focal seizure on the right perioral area and hand developed after minimal head trauma. Brain computed tomogram examination on admission showed small amount of chronic subdural hematoma on left fronto-parietal area. We planned conservative treatment with anticonvulsant, phenytoin. But, his seizure was sustained despite combination therapy of antiepileptic drugs including phenytoin and valproic acid, furthermore aggravated to complex partial seizure. Magnetic resonance image showed compression of motor cortex on the left hemisphere and electroencephalogram revealed seizure focus at the site of chronic subdural hematoma. He underwent craniotomy for hematoma evacuation, and operative field showed well demarcated margin between dark reddish hematoma and arachnoid membrane. However, his seizure was relapsed on 3rd postoperative day, and aggravated to "status epilepticus". The authors report this unusual case of status epilepticus from small amount of chronic subdural hematoma despite hematoma evacuation, and would like to emphasize early surgical intervention for the same cases.

Keyword

Chronic subdural hematoma; Seizure; Status epilepticus

MeSH Terms

Anticonvulsants
Arachnoid
Brain
Craniocerebral Trauma
Craniotomy
Electroencephalography
Hand
Hematoma
Hematoma, Subdural, Chronic
Magnetic Resonance Spectroscopy
Membranes
Motor Cortex
Phenytoin
Seizures
Status Epilepticus
Valproic Acid
Anticonvulsants
Phenytoin
Valproic Acid

Figure

• 

  FIGURE 1 Admission head CT shows chronic subdural hematoma with slightly low density on the left fronto-parietal area. However, brain compression is not certain when compared with right side.

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  FIGURE 2 Preoperative brain magnetic resonance image (MRI) is checked up because of sustained seizure despite combination of anticonvulsant medications. Both T1-weighted image (A) and T2 weighted image (B) shows high signal intensity on the area prior to central sulcus with same nature like CT. However, coronal section (C) reveals more compressive lesion than admission CT scans. The degree of brain parenchymal compression may be underestimated at the CT.

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  FIGURE 3 Intraoperative photograph. After dura is incised, dark reddish colored hematoma capsule is seen with well demarcated margin from arachnoid membrane and green tinged arachnoid membrane.

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  FIGURE 4 Immediate postoperative brain CT shows disappearance of hematoma, but slightly edematous change comparing with the right side.

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  FIGURE 5 After three months, there is no structural abnormality on brain CT scan.

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