A 77 y.o. woman presents with this CT after a fall
What complications can be expected from a subdural in this location?
Our patient presented with a complication of occipital lobe epilepsy. Following her fall and subdural she developed visual changes. She stated the R half of my face was gray and the L half was red. She often looked at things and they changed color or looked to be a color she knew they were not. She had trouble getting her eyes to “ work together.”
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Causes of occipital lobe epilepsy in addition to irritation caused by blood products:
-Reversible posterior leukoencephalopathy-malignant hypertension, eclampsiaand drugs like tacrolimus
-malformations of cortical development-cortical dysphasia, tuberous sclerosis
-tumors
-metabolic abnormalities, MELAS syndrome, hypercalcemia
Causes of occipital lobe epilepsy in addition to irritation caused by blood products:
-Reversible posterior leukoencephalopathy-malignant hypertension, eclampsiaand drugs like tacrolimus
-malformations of cortical development-cortical dysphasia, tuberous sclerosis
-tumors
-metabolic abnormalities, MELAS syndrome, hypercalcemia
You would also be correctif you answeredUPWARD herniation of the cerebellum through the tentorium. This is a complication of a bleed in the posterior fossa and makes giving TPA in the face of a posterior stroke problematic if a bleed occurs. The midbrain is pushed through the tentorial notch. This is also known as a transtentorial herniation since it occurs across the tentorium cerebelli.
Our patient was started on keppra and her visual changes resolved.
Ambrosetto G, Antonini L, Tassinaria CA. Occipital lobe seizures reated to clinically asymptomatic celiac disease in adulthood. Epilepsia 1992; 33 Suppl 4: 476-81.
Bakshi R, Bates VE, Mechtler LL, Kinkel PR, Kinkel QT. Occipital lobe seizures as the major clinical manifestation of reversible posterior leukoencephalopathy syndrome: magnetic resonance imageing findings. Epilepsia 1998;39: 295-9.
Munro D, Sisson W. Hernia through the incisura of the tentorium cerebelli in connection with craniocerebral trauma. NEJM. 1952247 (19), 699-708.