P-EP005. Recurrent focal seizure in subdural hemorrhage patient after anticoagulant oral therapy: Case report

Abstract

Introduction. Subdural Hemorrhage (SDH) which occurred during warfarin treatment is a bleeding complication related to anticoagulation intensity with a high level of mortality. Subdural hemorrhage can be associated with different neurological signs and symptoms including seizures. There is an increased risk of seizures in the first week after SDH, and this risk may persist for some time after surgical decompression. This case report aims to publish recurrent seizure in SDH patient after oral anticoagulant therapy at dr. Sardjito Hospital Yogyakarta, Indonesia. Results. A 25-year-old male patient was admitted to the Emergency Room Sardjito Hospital in October 2019, presented with recurrent focal seizure accompanied by impaired awareness, cephalgia with sign of increased intracranial pressure, and right hemiparesis. The patient has history of open-heart surgery with valve replacement and atrial fibrillation with normal ventricular response. He was on warfarin medication since September 2019. Physical examination revealed Glasgow Coma Scale (GCS) of compos mentis state and there were sign of meningeal irritation, right hemiparesis and increased physiological reflex on right extremity was observed, indicating upper motor neuron sign. Head CT scan revealed subdural hemorrhage on left fronto-temporo-parieto-occipitalis region and on the falx cerebri. After being transferred to stroke unit, the patient developed more frequent seizure, intense cephalgia and became somnolent. The seizure resolved after treatment with anti-edema, antiepileptic drug and craniotomy decompression. After 14 days of admission, cardiologist started low dose heparin to prevent valve occlusion. He was discharged from hospital after 25 days of admission with full consciousness, seizure-free and absence of neurological deficits. Conclusion. Treating the underlying cause and aggressive treatment is important after initial treatment with antiepileptic drug on subdural hemorrhage patient with recurrent seizures.