What is the likely cause of seizure in a patient with hydrocephalus secondary to an obstructing suprasellar (located above the sella turcica) mass?

From the Guidelines

The likely cause of seizures in a patient with hydrocephalus secondary to an obstructing suprasellar mass is increased intracranial pressure (ICP). When a suprasellar mass blocks the normal flow of cerebrospinal fluid (CSF), it leads to hydrocephalus, which is the abnormal accumulation of CSF within the brain's ventricles. This increased fluid causes elevated pressure within the cranial cavity, which can irritate the cerebral cortex and lower the seizure threshold, as noted in the presentation of pediatric central nervous system cancers 1. The compression and stretching of brain tissue, particularly in the temporal lobes, can disrupt normal neuronal activity and trigger abnormal electrical discharges resulting in seizures.

Some key points to consider in the management of such patients include:

• Addressing the underlying cause through surgical removal of the mass or CSF diversion procedures
• Use of antiepileptic medications to control seizures until the primary issue is resolved
• Monitoring for symptoms of increased intracranial pressure, such as headaches, nausea, and vomiting, as well as visual symptoms and gait disturbances, as seen in patients with pineal parenchymal tumors 1
• The importance of stabilizing the patient with precautions for high ICP and managing them in consultation with neurosurgery and critical care.

Given the potential for increased intracranial pressure and subsequent seizure activity, management should prioritize reducing ICP and preventing further neurological deterioration, with the goal of improving morbidity, mortality, and quality of life outcomes for the patient.

From the Research

Likely Cause of Seizure in a Patient with Hydrocephalus

• The likely cause of seizure in a patient with hydrocephalus secondary to an obstructing suprasellar mass is not directly addressed in the provided studies.
• However, study 2 suggests that hydrocephalus itself is not commonly recognized as a cause of seizures, but epilepsy is frequently associated with shunt-treated hydrocephalus, especially in children.
• The study 2 also mentions that the insult to the brain at the time of ventricular catheter insertion, the presence of the shunt tube itself as a foreign body, and the etiology of hydrocephalus are thought to be related to the risk of epilepsy.

Seizure Prophylaxis in Neurocritical Care

• Study 3 discusses the use of levetiracetam for seizure prophylaxis in patients with intracerebral hemorrhage, traumatic brain injury, supratentorial neurosurgery, and spontaneous subarachnoid hemorrhage.
• The study 3 found that levetiracetam may be preferred post supratentorial neurosurgery, but its efficacy in preventing seizures in other conditions is unclear.
• Studies 4, 5, and 6 provide information on the mechanism of action, pharmacokinetics, and efficacy of levetiracetam in the treatment of epilepsy, but do not directly address the cause of seizures in patients with hydrocephalus secondary to an obstructing suprasellar mass.

Treatment of Epilepsy

• Studies 4 and 5 discuss the use of levetiracetam as an adjunctive therapy for refractory partial-onset seizures, primary generalized tonic-clonic seizures, and myoclonic seizures of juvenile myoclonic epilepsy.
• Study 6 reviews the mechanisms of levetiracetam in the control of status epilepticus and epilepsy, but does not provide information on the cause of seizures in patients with hydrocephalus secondary to an obstructing suprasellar mass.