Subclinical Status Epilepticus in a Child after Closed Head Injury

A 14-year-old girl with closed head injury and a normal computerized tomographic scan underwent an electroencephalogrpahic tracing that surprisingly revealed typical status epilepticus electrical activity. No episodes of motor clinical convulsion were observed from the moment of trauma throughout the admission period. Treatment with phenytoin caused a dramatic clinical improvement. Repeated electroencephalogram (EEG) 4 days later was within normal limits. Posttraumatic seizures are reported after head injury, yet, the issue of "invisible" or "subclinical" seizures associated with trauma is not discussed. In these cases EEG, (an uncommon examination in the early period after head injury) may be the only tool for proper diagnosis and treatment with anticonvulsants. This case report raises the question of the role of EEG in the unconscious patient who does not present with obvious convulsions. Clinical indications for performing EEG after head trauma without seizures are discussed.