Chronic subdural haematoma:Clinical presentation, surgical treatment and outcome at the Lagos University Teaching Hospital

Abstract

Background Chronic subdural haematoma (CSDH) is a relatively common problem in neurosurgical practice worldwide with favourable prognosis when treated adequately. The incidence is about five per 100,000 per year in general population. Incidence is higher in the elderly, about 58 per  100,000 per year. Diagnosis of CSDH is still frequently missed or delayed in our environment with many patients often admitted and managed for various medical conditions before finally being referred for brain computerized tomographic scan.

Objective To determine the surgical outcome of patients treated for chronic subdural Haematoma in our environment.

Methods A surgical audit of 73 patients consecutively treated for CSDH at our institution between May 2005 and September 2010 to determine their demographic characteristics, clinical presentations and management outcome.

Results Majority of the patients were between 61 - 70 years. Sixty four percent of the patients had history of trauma; Only 2 patients were on anticoagulant therapy prior to presentation. The diagnosis was delayed or initially missed in 50% of the patients. Burrhole evacuation under general anaesthesia was the commonest operative procedure (96%). Five patients developed post operative complications; outcome was favourable in the majority (91.3%) of patients with a recurrence rate of 12.5% and mortality rate of 6.3%. Conclusion Despite frequent delay in diagnosis and  institution of treatment, surgical outcome is favourable in the majority of patients with CSDH many of whom are elderly.