Epilepsy after nonmissile depressed skull fracture

Summary: Purpose: To demonstrate risk factors involved in the origin of late posttraumatic seizures (LPTSs) in civilian traumatic brain injury (TBI) rehabilitation patients and the occurrence of LPTSs in this population. as well as the time of the first late seizures, and influence of these seizures o n functional and occupational long-term outcome.Mrtlrods: A consecutive sample of 490 patients (age range, 0.8-71 years) with TBI, and with postinjury problems in their education and employment, were followed up for 2 5 years from the time of injury in a rehabilitation and reemployment program. The study was carried out at the outpatient neurologic clinic of the Kauniala Hospital, which specializes in brain injuries in Finland and works in close cooperation with the Department of Clinical Neurosciences at the Helsinki University Central Hospital. Main outcome measures were functional outcome, as measured o n the Clasgow Outcome Scale (GOS), and the capacity for employment at the end of follow-up. Outcomes were studied separately among patients with late seizures and lor the nonseizure group.Ke.cu1t.s; Children age 7 years or younger at time of injury more often had early posttraumatic seizures (EPTSs). than did adolescents or adults. The time elapsed between brain injury and the first late seizure also was longer in older age groups. EPTSs and depressed skull fracture had a statistically significant relation to the origin of LPTSs. Permanent posttraumatic neurologic deficit, linear skull fracture, and permanent local brain lesion documented on 21 computed tomography (CT) scan appeared clinically important as risk factors. Late seizures did worsen the functional outcome but had n o significant influence on reemployment at the end of follow-up.Cowlusions: Young children are more prone to early seizures. and adolescents and adults, to late seizures. The main risk factors for LPTSs are early seizures and depressed skull fracture. Severity of brain injury, as measured by a low GCS score, prolonged unconsciousness, and posttraumatic amnesia (PTA) without local brain lesion, should not be considered risk factor for LPTSs. Thorough follow-up of patients with TBI with seizures and adequate antiepileptic therapy may help attain rehabilitation goals and reemployment.

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“…involved (21). In civilians, Jennet (22) first stated the close relation between skull fractures complicated by a torn dura and LPTSs.…”

Section: Discussionmentioning

confidence: 99%

Early and Late Posttraumatic Seizures in Traumatic Brain Injury Rehabilitation Patients: Brain Injury Factors Causing Late Seizures and Influence of Seizures on Long‐Term Outcome

1999

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“…The rate of posttraumatic epilepsy has not been shown to decrease after elevation of a fracture. 1,6 Posttraumatic headaches, learning disabilities, and behavioral problems are unlikely to be caused or improved by surgical intervention. Ten patients did die during their hospital admission as a result of the severe brain trauma; however, no deaths occurred after the initial hospitalization in any group.…”

Section: Discussionmentioning

confidence: 99%

Pediatric skull fractures: the need for surgical intervention, characteristics, complications, and outcomes

Bonfield¹,

Naran

Adetayo

et al. 2014

PED

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Object Head trauma is a common cause of morbidity and mortality in the pediatric population and often results in a skull fracture. Pediatric skull fractures are distinct from adult fractures. Pediatric fractures have a greater capacity to remodel, but the pediatric brain and craniofacial skeleton are still developing. Although pediatric head trauma has been extensively studied, there is sparse literature regarding skull fractures. The authors' aim was to investigate the characteristics, injuries, complications, and outcomes of the patients in whom surgical intervention was needed for skull fractures. Methods The authors performed a retrospective review of patients presenting to the emergency department of a pediatric Level I trauma center between 2000 and 2005 with skull fractures. Patient demographics, mechanism of injury, associated injuries, fracture bone involvement, surgical intervention, complications, and outcomes were analyzed. Groups treated nonoperatively, for skull fracture repair, and for traumatic brain injury were compared. Results A total of 897 patients with a skull fracture were analyzed. Most patients (n = 772, 86.1%) were treated nonoperatively (Non-Op group). Fifty-eight patients (6.5%) underwent repair of the fracture (Repair group) and 67 (7.5%) required intervention for treatment of traumatic brain injury (TBI group). The Non-Op group was significantly younger, and the TBI group had a lower initial Glasgow Coma Scale (GCS) score. A fall (51.2%) was the most common mechanism of injury in the Non-Op group, whereas a motor vehicle crash (23.9%) and being hit in the head with an object (48.2%) were most prevalent in the TBI and Repair groups, respectively. Associated injuries were seen in all 3 groups, with brain injury (hematoma) being the most common. Frontal bone fracture was seen most in the Repair and TBI groups, and the parietal bone was the most frequent bone fractured in the Non-Op group. Patients in the TBI group were much more likely to have 2 or 3 skull bones fractured. In the Repair group, 36.2% had a complication (38.0% intervention related and 62.0% trauma related), but no patient had a worsening of their neurological status. In the TBI group, 48.7% of the patients suffered a complication, the vast majority (90.6%) of which were related to the trauma. Conclusions The majority of pediatric skull fractures can be managed conservatively. Of those requiring surgical intervention, fewer than half of the surgeries are performed solely for skull fracture repair only. Patients hit in the head with an object or involved in a motor vehicle crash are more likely to need surgical intervention either to repair the skull fracture or for TBI management, respectively. Frontal bone fractures are more likely to necessitate repair, and those patients treated for TBI have a greater incidence of 2 or 3 bones involved in the fracture. Complications occurred but most were related to underlying trauma, not the surgery. No patients who underwent intervention for repair of their skull fracture only had a worsening of their neurological status.

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“…In the past, the classic recommendation for a simple depressed fracture was to surgically elevate it on the basis of concerns regarding the cosmetic effect, possible underlying pathological features, and epileptogenicity [7]. Since the 1960s, several studies have shown that for children without evidence of neurological or radiographic intracranial lesions, there were no differences between surgically treated and nonsurgically treated patients in terms of future neurological sequels or in the occurrence of seizures [5,8]. …”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment is required in cases where the fragments are depressed to the depth of at least one thickness of the skull, and in those with intracranial hematoma, cerebrospinal fluid leak, cosmetically deforming defects, gross wound contamination, and established wound infection [8,9]. …”

Section: Discussionmentioning

confidence: 99%

Spontaneous Elevation of a Ping-Pong Fracture: Case Report and Review of the Literature

et al. 2012

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Depressed skull fractures compromise 7-10% of the children admitted to hospital with a head injury. Depressed skull fractures that occur in children younger than 1 year are different from those found in older children. In neonates and infants, a depressed fracture forms an inward buckling of the bones forming a ‘cup shape', termed a ‘ping-pong fracture'. In neonates, spontaneous elevation of a ping-pong fracture after birth trauma is well documented. However, in infants, spontaneous elevation of a ping-pong fracture following head injury is extremely rare. Here, we present the case of an 11-month-old child, in whom a ping-pong fracture was spontaneously elevated within 2 h. In addition, the relevant literature is reviewed and discussed.

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Epilepsy after nonmissile depressed skull fracture

Cited by 64 publications

References 10 publications

Early and Late Posttraumatic Seizures in Traumatic Brain Injury Rehabilitation Patients: Brain Injury Factors Causing Late Seizures and Influence of Seizures on Long‐Term Outcome

Early and Late Posttraumatic Seizures in Traumatic Brain Injury Rehabilitation Patients: Brain Injury Factors Causing Late Seizures and Influence of Seizures on Long‐Term Outcome

Pediatric skull fractures: the need for surgical intervention, characteristics, complications, and outcomes

Spontaneous Elevation of a Ping-Pong Fracture: Case Report and Review of the Literature

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