Korean J Neurotrauma.  2015 Oct;11(2):144-146. 10.13004/kjnt.2015.11.2.144.

Fatal Post-Operative Epilepticus after Burr-Hole Drainage for Chronic Subdural Hematoma

• Lee KJ
• Eom KS
• Park JT
• Kim TY

• KMID: 2378274
• DOI: http://doi.org/10.13004/kjnt.2015.11.2.144

Abstract

Incidence of post-operative seizure after burr-hole trephination (BHT) for chronic subdural hematoma (CSDH) is known to be very low. The effect of the prophylactic antiepileptic drug in reducing the development of new seizure after surgery is still unclear. Here, we present a case of fatal status epilepticus with progressive respiratory complication following early discontinuation of prophylactic antiepileptic drug in an 84-year-old man who had undergone bilateral BHT and closed-system drainage for bilateral CSDH. Although the efficacy of the prophylactic anticonvulsants in BHT for CSDH has been controversial, the development of status epilepticus postoperatively seems to be strongly associated with an increased mortality rate in aged patients. Therefore, prophylactic anticonvulsants should be administrated in aged patients who undergo surgery for CSDH, until a definitive clinical treatment guideline is suggested.

Keyword

Aged; Anticonvulsants; Hematoma, subdural, chronic; Status epilepticus

MeSH Terms

Aged, 80 and over
Anticonvulsants
Butylated Hydroxytoluene
Drainage*
Hematoma, Subdural, Chronic*
Humans
Incidence
Mortality
Seizures
Status Epilepticus
Trephining
Anticonvulsants
Butylated Hydroxytoluene

Figure

• 

  FIGURE 1 Computed tomography scans reveal chronic subdural hematomas (asterisks) with mixed densities on bilateral cerebral convexities with mass effects.

• 

  FIGURE 2 A: Postoperative skull X-ray reveals fixed two fixed catheters through bilateral parietal burr-holes. B: Computed tomography scans obtained 3 days after the burr-hole trephination reveal significant decrease in bilateral chronic subdural hematomas without mass effects. The catheter is noted (white arrows) within subdural space.

Reference

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