By Joseph Driver, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, USA
Aislyn C. DiRisio, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, USA
Heidi Mitchell, Massachusetts General Hospital Institute of Health Professions, Boston, USA
Zachary D. Threlkeld, Department of Neurology, Massachusetts General Hospital and Brigham and Women’s Hospital, Harvard Medical Schoolm Boston, USA
William B. Gormley, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, USA
Neurocritical Care, February 2019, Volume 30, Issue 1, pp 16–21
Seizures due to subdural hematoma (SDH) are a common finding, typically diagnosed using electroencephalography (EEG). At times, aggressive management of seizures is necessary to improve neurologic recovery and outcomes. Here, we present three patients who had undergone emergent SDH evacuation and showed postoperative focal deficits without accompanying electrographic epileptiform activity. After infarction and recurrent hemorrhage were ruled out, seizures were suspected despite a negative EEG. Patients were treated aggressively with AEDs and eventually showed clinical improvement. Long-term monitoring with EEG revealed electrographic seizures in a delayed fashion. EEG recordings are an important tool for seizure detection, but should be used as an adjunct to, rather than a replacement for, the clinical examination in the acute setting. At times, aggressive treatment of suspected postoperative seizures is warranted despite lack of corresponding electrographic activity and can improve clinical outcomes.