CASE REPORT
Introdução: Convulsão é incomum ser relatada em paciente com hematoma subdural crônico (HSDC). A incidência de crises convulsivas no pós-operatório da drenagem do HSDC por trepanação (burr-hole) é considerada baixa. O uso profilático de drogas anticonvulsivantes no pré e pós-operatório do HSDC tem sido controverso. Descrição do caso: Homem de 79 anos, alcoolista crônico, que um mês após queda da própria altura apresentou cefaleia, crise convulsiva generalizada, sonolência e hemiparesia esquerda. A tomografia computadorizada de crânio evidenciou hematoma subdural de densidade mista no hemisfério cerebral direito. Foi submetido a drenagem por trepanação, porém apresentou crises convulsivas no pós-operatório imediato, com piora neurológica e evolução para óbito. Método: Relato de caso associado a revisão narrativa da literatura nas bases PubMed/MEDLINE, LILACS e SciELO (1970-2024). Conclusão: O uso de drogas anticonvulsivantes no paciente com HSDC permanece controverso, sem consenso quanto à profilaxia.
Introduction: Seizures are uncommonly reported in patients with chronic subdural hematoma (CSDH). The incidence of seizures in the postoperative period after burr-hole drainage of CSDH is considered low. The prophylactic use of anticonvulsant drugs in the pre- and postoperative period of CSDH remains controversial. Case presentation: We report a 79-year-old man with chronic alcoholism who, one month after a fall from his own height, presented with headache, a generalized seizure, drowsiness, and left hemiparesis. Cranial computed tomography showed a mixed-density subdural hematoma in the right hemisphere. He underwent burr-hole drainage but developed seizures in the immediate postoperative period, with neurological deterioration that progressed to death. Methods: A case report combined with a narrative review of the literature was conducted using the PubMed/MEDLINE, LILACS, and SciELO databases (1970-2024). Conclusion: The use of anticonvulsant drugs in patients with CSDH remains controversial, and no consensus has been reached regarding prophylaxis.
1. Rust T, Kiemer N, Erasmus A. Chronic subdural haematomas and anticoagulation or anti-thrombotic therapy. J Clin Neurosci. 2006;13(8):823-7. https://doi.org/10.1016/j.jocn.2004.12.013. PMid:16997707.
2. Hamou HA, Clusmann H, Schulz JB, Wiesmann M, Altiok E, Höllig A. Chronic subdural hematoma. Dtsch Arztebl Int. 2022;119(12): 208-13. PMid:35236548.
3. Wu L, Guo X, Ou Y, et al. Seizure after chronic subdural hematoma evacuation: associated factors and effect on clinical outcome. Front Neurol. 2023;14:1190878. https://doi.org/10.3389/fneur.2023.1190878. PMid:37228408.
4. Pradhanang AB, Sedain G, Shilpakar SK, Sharma MR. Prophylactic use of anti-epileptic drug (phenytoin) in preventing early postoperative seizure in patients with chronic subdural hematoma: a randomized control trial. Indian J Neurosurg. 2019;8(3):168-78. https://doi. org/10.1055/s-0039-1698478.
5. Goertz L, Speier J, Schulte AP, et al. Independent risk factors for postoperative seizures in chronic subdural hematoma identified by multiple logistic regression analysis. World Neurosurg. 2019;132: e716-21. https://doi.org/10.1016/j.wneu.2019.08.032. PMid:31421304.
6. Faruk MO, Kuddus MR, Sharif MS, Barua KK. Preventing postoperative seizures in chronic subdural hematoma surgery: role of antiepileptic drugs. Int J Clin Trials. 2025;12(2):74-9. https://doi.
org/10.18203/2349-3259.ijct20251202.
7. Luxon LM, Harrison MJG. Chronic subdural haematoma. Q J Med.
1979;48(189):43-53. https://doi.org/10.1093/oxfordjournals.qjmed. a067565. PMid:482590.
8 . Ohno K, Maehara T, Ichimura K, Suzuki R, Hirakawa K, Monma S. Low incidence of seizures in patients with chronic subdural haematoma.
J Neurol Neurosurg Psychiatry. 1993;56(11):1231-3. https://doi. org/10.1136/jnnp.56.11.1231. PMid:8229039.
9. Seuk JW, Chun HJ, Yi HJ. Status epilepticus caused by small amount subacute to chronic subdural hematoma: case report and review of literatures. J Korean Neurotraumatol Soc. 2010;6(2):154-7. https://doi. org/10.13004/jknts.2010.6.2.154.
10. Cameron MM. Chronic subdural haematoma: a review of 114 cases. J Neurol Neurosurg Psychiatry. 1978;41(9):834-9. https://doi. org/10.1136/jnnp.41.9.834. PMid:690655.
11. Kotwica Z, Brzezinski J. Early and late results of the surgical treatment of chronic subdural hematoma. Neurol Neurochir Pol. 1987; 21(4-5):376-80. PMid:3444508.
12. Grisoli F, Graziani N, Peragut JC, et al. Perioperative lumbar injection of Ringer’s lactate solution in chronic subdural hematomas: a series of 100 cases. Neurosurgery. 1988;23(5):616-21. https://doi. org/10.1227/00006123-198811000-00012. PMid:3059219.
13. Hirakawa K, Hashizume K, Fuchinoue T, et al. Statistical analysis of chronic subdural hematoma in 309 adult cases. Neurol Med Chir. 1972;12(0):71-83. https://doi.org/10.2176/nmc.12.71. PMid:4135996.
14. Sabo RA, Hanigan WC, Aldag JC. Chronic subdural hematomas and seizures: the role of prophylactic anticonvulsive medication. Surg Neurol. 1995;43(6):579-82. https://doi.org/10.1016/0090-3019(95)00155-7. PMid:7482238.
15. Rubin G, Rappaport ZH. Epilepsy in chronic subdural haematoma. Acta Neurochir. 1993;123(1-2):39-42. https://doi.org/10.1007/ BF01476283. PMid:8213276.
16. Won SY, Konczalla J, Dubinski D, et al. A systematic review of epileptic seizures in adults with subdural haematomas. Seizure. 2017;45:28-35. https://doi.org/10.1016/j.seizure.2016.11.017. PMid:27914224.
17. Flores G, Vicenty JC, Pastrana EA. Post-operative seizures after burr hole evacuation of chronic subdural hematomas: is prophylactic antiepileptic medication needed? Acta Neurochir (Wien). 2017;159(11):2033-6. https://doi.org/10.1007/s00701-017-3298-6. PMid:28808801.
18. Lee KJ, Eom KS, Park JT, Kim TY. Fatal postoperative epilepticus after burr hole drainage for chronic subdural hematoma. Korean J Neurotrauma. 2015;11(2):144-6. https://doi.org/10.13004/kjnt.2015.11.2.144. PMid:27169081.
19. Huang YH, Yang TM, Lin YJ, et al. Risk factors and outcome of seizures after chronic subdural hematoma. Neurocrit Care. 2011;14(2):253-9. https://doi.org/10.1007/s12028-011-9509-8. PMid:21286854.
20. Nachiappan DS, Garg K. Role of prophylactic antiepileptic drugs in chronic subdural hematoma – a systematic review and meta-analysis. Neurosurg Rev. 2021;44(4):2069-77. https://doi.org/10.1007/s10143020-01388-y. PMid:32910368.
21. Chen CW, Kuo JR, Lin HJ, et al. Early post-operative seizures after burr-hole drainage for chronic subdural hematoma: correlation with brain CT findings. J Clin Neurosci. 2004;11(7):706-9. https://doi. org/10.1016/j.jocn.2004.03.019. PMid:15337129.
22. Rabinstein AA, Chung SY, Rudzinski LA, Lanzino G. Seizures after evacuation of subdural hematomas: incidence, risk factors, and functional impact. J Neurosurg. 2010;112(2):455-60. https://doi.
org/10.3171/2009.7.JNS09392. PMid:19698050.
23. Battaglia F, Lubrano V, Ribeiro-Filho T, Pradel V, Roche PH. Incidence and clinical impact of seizures after surgery for chronic subdural hematoma. Neurochirurgie. 2012;58(4):230-4. https://doi. org/10.1016/j.neuchi.2012.04.002. PMid:22626817.
24. Caveness WF, Portera A, Scheffner D. Epilepsy, a product of trauma in our time. Epilepsia. 1976;17(2):207-15. https://doi.
org/10.1111/j.1528-1157.1976.tb03398.x. PMid:820549.
25. Cole M, Spatz E. Seizures in chronic subdural hematoma. N Engl J Med. 1961;265(13):628-31. https://doi.org/10.1056/ NEJM196109282651304. PMid:13694560.
26. Chan AW. Alcoholism and epilepsy. Epilepsia. 1985;26(4):323-33. https://doi.org/10.1111/j.1528-1157.1985.tb05658.x. PMid:3891322.
27. Hamou H, Alzaiyani M, Rossmann T, et al. Seizure after surgical treatment of chronic subdural hematoma – associated factors and effect on outcome. Front Neurol. 2022;13:977329. https://doi.org/10.3389/ fneur.2022.977329. PMid:36158969.
28. Brodersen P, Gjerris F. Regional cerebral blood flow in patients with chronic subdural hematomas. Acta Neurol Scand.
1975;51(3):233-9. https://doi.org/10.1111/j.1600-0404.1975. tb07604.x. PMid:125025.
29. Ghoneim MA, Abbass W. Anticonvulsants for preventing seizures in patients with chronic subdural haematoma: pilot study. Open J Mod Neurosurg. 2020;10(2):237-43. https://doi.org/10.4236/ ojmn.2020.102025.
30. Kramer A, Degenhartt X, Gutenberg A, Ringel F. Risk factors for postoperative seizures in patients with chronic subdural haematomas. Neurosurg Rev. 2022;45(5):3291-8. https://doi.org/10.1007/s10143022-01858-5. PMid:36097085.
31. Lavergne P, Labidi M, Brunet MC, et al. Efficacy of antiseizure prophylaxis in chronic subdural hematoma: a cohort study on routinely collected health data. J Neurosurg. 2019;132(1):284-8. https://doi. org/10.3171/2018.9.JNS182092. PMid:30660118.
32. Ratilal BO, Pappamikail L, Costa J, Sampaio C. Anticonvulsants for preventing seizures in patients with chronic subdural haematoma.
Cochrane Database Syst Rev. 2013;2013(6):CD004893. https://doi. org/10.1002/14651858.CD004893.pub3. PMid:23744552.
33. Branco PM, Ratilal BO, Costa J, Sampaio C. Antiepileptic drugs for preventing seizures in patients with chronic subdural hematoma. Curr Pharm Des. 2017;23(42):6442-5. https://doi.org/10.2174/1381612823 666171024144318. PMid:29076415.
34. Grobelny BT, Ducruet AF, Zacharia BE, et al. Preoperative antiepileptic drug administration and the incidence of postoperative seizures following bur hole-treated chronic subdural hematoma. J Neurosurg. 2009;111(6):1257-62. https://doi.org/10.3171/2009.6.JNS0928.
PMid:19558304.
35. Temkin NR. Antiepileptogenesis and seizure prevention trials with antiepileptic drugs: meta-analysis of controlled trials. Epilepsia. 2001;42(4):515-24. https://doi.org/10.1046/j.1528-1157.2001.28900.x.
PMid:11440347.
1Neurosurgery Division, Universidade Federal do Sergipe – UFS, Aracaju, SE, Brasil.
2Faculty of Medicine, Universidade Federal do Triângulo Mineiro – UFTM, Uberaba, MG, Brasil.
Received Jun 1, 2026
Accepted Jun 25, 2026
