Acute-on-chronic subdural hematoma: a new entity for prophylactic anti-epileptic treatment?

  • 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.

Download full text files

Export metadata

Author:Sae-Yeon WonORCiDGND, Daniel DubinskiORCiDGND, Thomas Michael FreimanORCiDGND, Volker SeifertORCiD, Florian GeßlerORCiDGND, Adam StrzelczykORCiDGND, Jürgen KonczallaORCiDGND
Parent Title (English):European journal of trauma and emergency surgery
Publisher:Springer Medizin
Place of publication:Heidelberg
Document Type:Article
Date of Publication (online):2020/09/28
Date of first Publication:2020/09/28
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2023/08/03
Tag:Acute-on-chronic subdural hematoma; Outcome; Seizure; Status epilepticus
Page Number:10
First Page:933
Last Page:942
Open Access funding enabled and organized by Projekt DEAL.
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - CC BY - Namensnennung 4.0 International