Acute-on-chronic subdural hematoma: a new entity for prophylactic anti-epileptic treatment?
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ORIGINAL ARTICLE
Acute‑on‑chronic subdural hematoma: a new entity for prophylactic anti‑epileptic treatment? Sae‑Yeon Won1 · Daniel Dubinski1 · Thomas Freiman1,2 · Volker Seifert1 · Florian Gessler1,2 · Adam Strzelczyk3 · Juergen Konczalla1 Received: 18 July 2020 / Accepted: 18 September 2020 © The Author(s) 2020
Abstract 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. Keywords Acute-on-chronic subdural hematoma · Seizure · Status epilepticus · Outcome
Introduction Chronic subdural hematoma (cSDH) is a disease with an increasing annual incidence in the United States, currently estimated at 7.2–10.3 per 100,000 persons and predicted to increase up to 17.1 per 100,000 persons by 2030, due to aging demographic alterations [13]. Elderly people are * Sae‑Yeon Won sae‑[email protected] 1
Department of Neurosurgery, University Hospital, Goethe University, Schleusenweg 2‑16, 60528 Frankfurt, Germany
2
Department of Neurosurgery, University Medicine of Rostock, Rostock, Germany
3
Department of Neurology and Epilepsy Center Frankfurt Rhine‑Main, University Hospital, Goethe-University, Frankfurt am Main, Germany
primarily affected by cSDH, which is associated with substantial morbidity and mortality. The relevance of cSDH has, therefore, increased in both clinical practice and research. Seizures are well-known complications of cSDH, with an incidence rate ranging from 2 to 15.2%, and have been shown to be an independent predictor of un
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