HEAD-INJURIES DUE TO FALLS CAUSED BY SEIZURES - A GROUP AT HIGH-RISK FOR TRAUMATIC INTRACRANIAL HEMATOMAS

This prospective review of adult patients with head injuries examines the incidence of head injuries due to falls caused by seizures, the in cidence and severity of intracranial hematomas, and the morbidity and mortality rates in this patient population. A head injury was attribut ed to a fall caused by a seizure if the seizure was witnessed to have caused the fall, or the patient had a known seizure history, appeared postictal or was found convulsing after the fall, and no other cause f or the fall was evident. A total of 1760 adult head-injured patients w ere consecutively admitted to the authors' service between 1986 and 19 93. Five hundred eighty-two head injuries (33.1%) were due to falls an d 22 (3.8%) of these were caused by seizures. Based on the prevalence rates for epilepsy in the general population of 0.5 to 2%, these resul ts indicate that epileptics are several times more likely to suffer a head injury due to a fall. Mass lesions were found in 20 (90.9%) of th ese 22 patients and the remaining two patients suffered mild diffuse h ead injuries. There was a high incidence of extraaxial mass lesions: 1 7 (85%) of the 20 intracranial hematomas were either epidural (five ca ses) or acute subdural (12 cases) hematomas. Eighteen (81.8%) of the 2 2 patients required evacuation of a hematoma. Both the incidence of in tracranial hematomas (90.9% vs. 39.8%; p < 0.001, chi-square analysis) and the rate of hematoma evacuation (81.8% vs. 32.3%; p < 0.001) was significantly greater in patients injured in falls due to seizures (22 cases) than in the group injured in falls from all other causes (560 cases). The higher incidence of hematomas and the need for evacuation were not explained by differences in age, severity of head injury, or incidence of alcohol intoxication. Despite the greater incidence of ma ss lesions and the need for operative treatment in patients injured be cause of seizures, their mortality rate was similar to that of patient s injured in falls from other causes.On the basis of their review of p atients admitted to a neurosurgical center with complaints of head inj ury, the authors conclude that patients with head injuries due to a fa ll caused by a seizure should undergo computerized tomography scanning early in their management. Until a mass lesion has been excluded, any decrease in level of consciousness or focal neurological deficit shou ld not be attributed to the seizure itself.