TY  - JOUR
A1  - Won, Sae-Yeon
A1  - Dubinski, Daniel
A1  - Freiman, Thomas Michael
A1  - Seifert, Volker
A1  - Geßler, Florian
A1  - Strzelczyk, Adam
A1  - Konczalla, Jürgen
T1  - Acute-on-chronic subdural hematoma: a new entity for prophylactic anti-epileptic treatment?
T2  - European journal of trauma and emergency surgery
N2  - Purpose: Acute-on-chronic subdural hematoma (acSDH) describes acute bleeding into a chronic subdural hematoma (SDH), after surgery or second trauma. Because seizures are a well-known complication of SDH, associated with substantial morbidity and mortality, we aimed to analyze the incidence of acute symptomatic seizures (ASz), including status epilepticus, and determine the functional outcomes in this specific cohort of patients.
Methods: A retrospective analysis was performed, including patients with acSDH who were admitted to our department between 2010 and 2019. The incidence and timely onset of ASz and status epilepticus were evaluated. Functional outcomes at discharge and at 3–6 month follow-up were analyzed based on the modified Rankin scale.
Results: Of 506 patients with chronic SDH, 29 patients (5.7%) were diagnosed with acSDH. The overall incidence of ASz and status epilepticus were 72.4% and 10.3%, respectively. Favorable outcomes were identified in 11 patients (52.4%) in the ASz group compared with 6 patients (75%) in the non-ASz group. The mortality rate was higher in the ASz group compared with that in the control group (29% vs 0%). At follow-up, favorable outcomes were similar to those observed at discharge (52.4% in the ASz group and 71.4% in the control group). The mortality rate was still higher in the ASz group, at 32% compared with 14% for the control group.
Conclusion: AcSDH has a high risk for ASz, including status epilepticus, and is associated with unfavorable outcomes and high mortality. Thus, prophylactic treatment with antiepileptic drugs should be considered among this specific cohort of patients.
KW  - Acute-on-chronic subdural hematoma
KW  - Seizure
KW  - Status epilepticus
KW  - Outcome
Y1  - 2020
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/74605
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-746051
SN  - 1863-9941
N1  - Open Access funding enabled and organized by Projekt DEAL.
VL  - 48
IS  - 2
SP  - 933
EP  - 942
PB  - Springer Medizin
CY  - Heidelberg
ER  -