The outcome of chronic subdural haematoma

Abstract

Objective: To determine the outcome of chronic subdural haematoma. Study design: Descriptive prospective observational study. Setting: Kenyatta National Hospital. This is tertiary referral hospital in the country and serves as teaching hospital to The University of Nairobi Medical School. Materials and methods: Sixty three consecutive patients who had computerized tomography scan diagnosis of chronic subdural haematoma on admission were recruited to the study between July 2007 and January 2008 and information entered into a standardized questionnaire. Markwalder grade was used to asses patients on admission, before discharge and at 3 and 6 months follow up. Patients were followed in neurosurgical clinic up to six months. Data was entered into SPSS and Chi square and fishers exact were used to correlate data. P value < 0.05 was considered significant. RESULTS: The age distribution ranged from 7-93years with mean age of 58.12 years while male: female ratio was 2.2: 1. The commonest presenting symptom was headache in thirty four (54%) while altered level of consciousness was the predominant sign in thirty (50.8%) of patients. The commonest cause was trauma in thirty five patients (55.5%) while alcohol was an associated cause in eighteen patients (28.6%). Majority of patients presented 2-4weeks after trauma (58.1%) and elderly patients had the longest duration between trauma and presentation. Surgery was the main treatment option with burr hole craniostomy comprising 100% of all initial operations. There was improvement in neurological status with normal status (Markwalder grade 0) being 1.6% at admission, 75% at discharge and 88.65% and 90.9% at 3 and 6 months respectively. All patients with re-accumulation were above 50 years, had trabecular haematoma type and hypodense haematoma density. Recurrence rate of 6.4% was noted. Majority of patients with recurrence had hypodense rhaematoma (50%) while separated and homogenous haematoma types contributed 50% each. All patients with recurrence in this study were males. Mortality rate was 17% and most patients who died were above 50 years and had -other diseases. Surgeon qualification, haematoma thickness and midline shift had no relation to outcome in this study. There was no relation between age and recurrence. Death had no relationship with haematoma type, haematoma density, age, sex and duration between trauma and presentation. Conclusion: Majority of patients were above 50 years with male: female ratio of 2.2: 1. Though patient's presentation compared with other studies, confusion at 23.9% was higher in this study. Age had no relation to presentation except visual defects in patients below 50 years and hemiparesis in patients above 50 years. Trauma was the commonest cause and elderly patients had the longest duration between trauma and presentation. There was improvement in neurological status with Markwalder grade zero 0), being 1.6% on admission, 75% at discharge, 88.6% at 3 months and 90.9% at six months. Haematoma thickness and midline shift had no relation to outcome. Post-operative complications were seizures in five (7.9%), infections in five (7.9%), recurrence in four (6.4%), re-accumulation in two (3.2%) and haemorrhage in two (3.2%) patients. Mortality rate was 17.5% in this study. Patients above 50 years, males, patients with co-morbid factors and poor neurological grade on admission had highest mortality rate. There was no statistical significance between death and haematoma type, haematoma density, sex, age, haematoma thickness and midline shift.