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Published on: June 21, 2019
[Clinical and radiological studies of seizure in chronic subdural hematoma--case control study]
Shuichiro Neshige1, Yoshinobu Sekihara, Norihiro Ishii
1Department of Neurology, Brain Attack Center, Ota Memorial Hospital.
Insights
Chronic subdural hematoma can cause seizures, particularly in patients with dementia. Mixed-density hematomas and sulcal hyperintensity on MRI suggest a mechanism involving brain infiltration and stimulation.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Chronic subdural hematoma (CSDH) is a common neurosurgical condition.
- Seizures are a known complication of CSDH, but the underlying mechanisms require further elucidation.
- Understanding these mechanisms is crucial for improving patient outcomes and treatment strategies.
Purpose of the Study:
- To investigate the mechanism of seizure induction in patients with CSDH.
- To identify clinical and radiological factors associated with seizures in CSDH patients.
- To explore the relationship between hematoma characteristics and seizure occurrence.
Main Methods:
- A retrospective study of 1,009 patients with CSDH.
- Comparison of a seizure group (n=26) with a non-seizure group (n=40).
- Analysis of clinical parameters, radiological findings (CT and MRI), and patient history.
Main Results:
- 2.6% of CSDH patients experienced seizure-related complications.
- Dementia was more prevalent in the seizure group.
- Bilateral hematomas and sulcal hyperintensity on FLAIR MRI were significantly more frequent in the seizure group; many of these patients had mixed-density hematomas on CT.
Conclusions:
- Hematoma content infiltration into the brain parenchyma may induce seizures.
- Mixed-density hematomas and associated sulcal hyperintensity are potential indicators of seizure risk in CSDH.
- Further research into the neurochemical and inflammatory components of CSDH may reveal novel therapeutic targets.
Abstract:
We studied the mechanism underlying seizure induction in patients with chronic subdural hematoma. In our study population of 1,009 patients with chronic subdural hematoma, 26 (2.6%) had seizure-related complications. Six of them had already been diagnosed with epilepsy (4 patients) or suspected of having secondary epilepsy (2 patients) after experiencing traffic accidents or cerebral bleeding. Twenty patients (seizure group) had been tentatively diagnosed as having hematoma-induced convulsion. Of the remaining 989 patients without convulsion, 40 randomly sampled patients were included in the non-seizure group by matching with clinical terms. Intergroup comparisons showed that patients with dementia were more common in the seizure group than in the non-seizure group; however, no intergroup differences were observed for other clinical parameters. Radiological examinations showed that bilateral hematomas were relatively more common and sulcal hyperintensity on FLAIR MR images was significantly more frequent in the seizure group than in the non-seizure group. Interestingly, many patients presenting with sulcal hyperintensity exhibited mixed-density hematomas on CT images. These findings suggest the mechanism by which hematoma content infiltrates into the brain parenchyma and the subsequent induction of convulsions by the stimulatory component.
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