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

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.