• Joseph S Yazdi and Jean A Schumaker.
• Division of Neurosurgery, St. Elizabeth's Hospital, Belleville, Illinois, USA. Electronic address: joeyaz21@yahoo.com.
• World Neurosurg. 2016 Nov 1; 95: 620.e1-620.e7.

BackgroundOne of the risks of a traumatically induced intracranial bleed is development of new onset seizures. Rarely would these seizures progress to status epilepticus (SE) or refractory SE. There is a lack of literature on the use of a vagus nerve stimulator in these situations in older adults.Case DescriptionWe present a 67-year-old patient who developed refractory status epilepticus within days after evacuation of a right-sided spontaneous subdural hematoma. He was refractory to multiple antiepileptic agents and phenobarbiturate- and propofol-induced coma. He then underwent a left vagus nerve stimulator (VNS) implantation. Within a few days of implantation, he improved dramatically. Within 2 weeks of VNS implantation, he was neurologically intact and was transferred to an inpatient rehabilitation facility. Within a short time thereafter, he was fully functional and able to take care of all of his activities.ConclusionsA vagus nerve stimulator should be considered in cases of refractory status epilepticus, regardless of age. Excellent outcome can be achieved even if a short course of medication-induced coma is unsuccessful.Copyright © 2016 Elsevier Inc. All rights reserved.

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