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J Neurol Surg A Cent Eur Neurosurg 2019; 80(04): 233-239
DOI: 10.1055/s-0039-1677824
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Clinical Relevance of Seizure in Pediatric Patients with Isolated Acute Subdural Hematoma without Parenchymal Brain Injury

Sae-Yeon Won
1   Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
,
Daniel Dubinski
1   Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
,
Bedjan Behmanesh
1   Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
,
Adam Strzelczyk
2   Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe-University, Frankfurt am Main, Germany
,
Volker Seifert
1   Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
,
Juergen Konczalla   *
1   Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
,
Thomas M. Freiman   *
1   Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
› Author Affiliations Funding No funding was received for this research.
Further Information

Publication History

13 April 2018

05 September 2018

Publication Date:
20 March 2019 (online)

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Abstract

Purpose Isolated acute subdural hematoma (aSDH) in pediatric patients is rare, but it has a major impact on outcome. The purpose of this study was to determine incidence, seizure risk factors, and the outcome of pediatric patients with aSDH.

Methods Within a 10-year period (2007–2016), 10 children with aSDH were identified. Baseline characteristics and these parameters were analyzed: pediatric Glasgow Coma Scale (pGCS) score at admission and 24 hours after the operation, hematoma volume/side, and midline shift. Functional outcome was assessed at 3-month follow-up using the King's Outcome Scale for Childhood Head Injury score.

Results Three subgroups were identified depending on age and etiology: birth-associated, nontraumatic, and traumatic aSDH. The overall incidence of seizures was 60%, and an even higher rate (75%) was observed in children < 1 month of age. Of those patients, two (67%) developed late seizures. Significant predictors for seizures were low pGCS score at admission (p = 0.03) and 24 hours after surgery (p = 0.03) as well as increased midline shift (p = 0.02). Patients with seizures tended to have an unfavorable outcome.

Conclusion Pediatric patients with aSDH are at high risk for seizures, particularly if the pGCS score is low at admission/24 hours after the operation and midline shows a shift. Determining seizure-prone pediatric patients may facilitate early antiepileptic treatment and promote better clinical outcomes.

Keywords

acute subdural hematoma - seizure - incidence - risk factors - pediatric

* Shared last authorship and contributed equally.


 

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