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Clinical case studies have long been recognized as a useful adjunct to problem-based learning and continuing professional development. They emphasize the need for clinical reasoning, integrative thinking, problem-solving, communication, teamwork and self-directed learning - all desirable generic skills for health care professionals. Epilepsy is amongst the most frequently encountered of neurological disorders. There are important emerging clinical management issues (e.g., first seizure, therapy-resistant seizures, ICU, pregnancy) but also differential diagnosis of non-epileptic seizures (syncopy, pseudo-seizure, paroxysmal dystonic syndromes, sleep disorders, psychosis, inborn errors of metabolism, etc.). This selection of epilepsy case studies will inform and challenge clinicians at all stages in their careers. Including both common and uncommon cases, Case Studies in Epilepsy reinforces the diagnostic skills and treatment decision-making processes necessary to treat epilepsy and other seizures confidently. Written by leading experts, the cases and discussions work through differential diagnoses, treatments and social consequences in pediatric and adult patients.
This chapter presents the diagnostic tests and principles of management for intracerebral hemorrhage (ICH), subdural hematoma (SDH) and extradural hemorrhage (EDH). ICH is twice as common as subarachnoid hemorrhage (SAH) and more likely to result in death or major disability. Cerebrovascular disease (CVD) is the most commonly identified antecedent of epilepsy in adults, accounting for 11% of cases. Intracerebral hemorrhage is the most lethal form of stroke and is a medical emergency. Prompt imaging studies are required because clinical presentation alone is insufficient to differentiate ICH from stroke due to other causes. Scanning with computed tomography (CT) and magnetic resonance imaging (MRI) are first-choice options. Catheter-directed or minimally invasive endoscopic surgery for clot evacuation using tissue-type plasminogen activator may hold promise in selected patients. Retrospective studies of small numbers of patients conclude that the routine use of prophylactic anticonvulsants is of no benefit after clipping or coil embolization.