Post Traumatic Epilepsy with Sequel of Frontal Contusion and Spontaneous Regression of Extradural Hematoma; Clinical Case and Review of the Literature

Abstract

Post traumatic epilepsy are frequent complications of moderate and severe head injuries, they are found in hemorrhagic contusions and hematomas. Several isolated or associated mechanisms are involved in the occurrence of these convulsions (increased inflammatory markers, neuronal cell death, altered blood-brain barrier, changes in astrocytes, and glucose metabolism dysregulation changes in synaptic abundance and function).The first attacks can occur more than 2 years after the head trauma or after cranial surgery. Preventive treatment does not change the course of the disease. Treatment with Valproate and levetiracetam were also compared to phenytoin and no benefit was found in recovery.
 The particularity of our patient is the severe head trauma, with regressive frontal contusion with secular lesions, followed by the appearance at nearly three and a half months of the trauma of a fronto-parietal extradural hematoma with mass effect which resolved spontaneously. Two and three years after the trauma, he developed generalized epilepsy, suggesting post-traumatic epilepsy following the sequelae of the hemorrhagic contusion or the extradural hematoma, or the sequelae of these associated lesions. These seizures were treated with sodium valproate. This clinical case challenges clinicians to monitor in severe head injuries the occurrence of complications such as epilepsy that can occur beyond 2 years.