Outcomes In Patients with Traumatic Acute Subdural Hematoma with Non-Convulsive Status Epilepticus
Nasser Mohammed1, Katelyn Stebbins2, Aashit Shah3
1Neurology, Carilion Clinic-Virginia Tech school of medicine, 2Neurology, Fralin Biomedical Research Institute at VTC, 3Neurology, Carilion Clinic
Objective:
To evaluate the factors contributing to poor outcomes in patients with acute traumatic subdural hematoma (aSDH) who developed nonconvulsive status epilepticus (NCSE).
Background:
NCSE in patients with aSDH is an underdiagnosed yet fatal complication that requires prompt diagnosis and treatment. A high degree of clinical suspicion and evaluation with continuous EEG is required for prompt diagnosis and treatment.
Design/Methods:
This is a single-institution retrospective study approved by the local IRB. Patients with traumatic brain injury (TBI) with aSDH diagnosed with status epilepticus between the years 2016-2020 were included. Demographic, clinical, imaging, treatment, and EEG details were reviewed and collected in a HIPPA-compliant format. Logistic regression analysis was used to evaluate factors contributing to poor outcomes.
Results:
Out of a total of 540 patients, who had presented with traumatic acute intra-cerebral hemorrhage between the years 2016-2022, 28 patients with traumatic aSDH who had presented with status epileptics during the same hospitalization were included in the present study. NCSE was the most common form of status epilepticus (27/28). The mean age was 67 (range 20-92) years and 17(60%) were male. 12(48%) of the patients had an initial presenting GCS of 7 or less. The mean length of stay in the hospital was 16 (5-44) days. Overall mortality was 19(64%). Logistic regression analysis identified the presence of central spikes on EEG (p:0.43, OR:12.72; 95% CI 1.083-149.35) and thickness of aSDH> 1cm (p: 0.025; OR: 16.545; 95%CI: 1.426-191.95) as predictors of mortality in both univariate and multivariate analysis. Good functional outcomes with mRS<2 were seen in rarely 10(35%) of these patients.
Conclusions:
Nonconvulsive status epilepticus (NCSE) is a common form of presentation of status epilepticus in patients with acute traumatic SDH. The presence of epileptiform activity in the central leads in EEG often leads to resistant seizures. NCSE carries a poor prognosis with high mortality.