A Prospective Clinical Study on Chronic Subdural Hematoma with Special Reference to Its Surgical Management at a Tertiary Care Hospital in North-East India

BACKGROUND Chronic subdural hematoma (CSDH) is one of the commonest disease that affects elderly people. Presentation mimics many other diseases of elderly. Timely diagnosis and prompt surgical intervention is the key to favourable outcome. This study was done to obtain baseline data on its various modes of presentation and management in a tertiary care hospital in north east India. METHODS This prospective observational study was conducted at Assam Medical College and Hospital, Dibrugarh, Assam from June 2016 to end of May 2017. All radiologically confirmed patients with CSDH were included fulfilling the inclusion and exclusion criteria. All patients underwent surgical intervention as per indication. All patients were evaluated in regard of presenting clinical features, radiological findings, treatment received, peri-operative complications, outcome and other clinical variables during hospital stay and follow up. RESULTS A total of 52 patients were included in the study. Male and female ratio was 3: 1 and 73.08 % patients were aged more than 50 years. Headache was the most common symptom followed by altered sensorium, limb weakness, intermittent vomiting, convulsions and others. History of recent trauma was found in 67.31 % and chronic alcoholism in 28.85 % of patients. Most of the patient (63.46 %) had Glasgow coma scale (GCS) score 13 - 15. Pure CSDHs were found in 19.23 % and mixed density CSDHs in 80.77 % of patients. Burr hole was done in 48 patients (92.30 %) and craniotomy in 7 (13.46 %). Electrolyte imbalance was observed in 17.31 % of patients followed by seizures, pulmonary complications and others. Four patient had moderate disability at the time of discharge and at the end of one month all discharged patient had good recovery. CONCLUSIONS Chronic subdural hematoma is one the common benign disease of old age which requires high level of suspicion for diagnosis and early radiological investigation. Timely surgical intervention carries minimal risk of complications with good recovery for most of the patients. Burr hole is the preferred surgical procedure for CSDHs with craniotomy reserved for some selected cases. KEYWORDS Chronic Subdural Hematoma, Surgical Management, Burr Hole, Craniotomy

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Etiology and Surgical outcome of chronic Subdural hematoma at Tertiary Care Hospital.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.12.3560 ◽

2019 ◽

Vol 26 (12) ◽

pp. 2156-2161

Author(s):

Hameedullah Khan ◽

Ihsanullah Rajar ◽

Abdul Rauf Memon ◽

Nadeem Naeem ◽

Zeeshan Ul Haque

Keyword(s):

Survival Rate ◽

Head Injury ◽

Subdural Hematoma ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

Care Hospital ◽

Burr Hole Evacuation ◽

One Year

Objectives: To determine etiology and management outcome among patients presenting with chronic subdural hematoma at tertiary care Hospital. Study Design: Cross Sectional. Setting: Department of neurosurgery, Liaquat University Hospital, Hyderabad/Jamshoro. Period: One year from 2015 to 2016. Material & Methods: All the patients with diagnosis of unilateral chronic subdural hematoma, and both male and female gender were included in this study. CT scan and other relevant laboratory investigations were done. All the patients underwent treatment of burr hole evacuation after taken informed consent. Antibiotics were given to all the patients pre- and post-operatively. All the subjects underwent CT scan for the evaluation of hematoma cavity. Patients were discharged generally following 1-week and were followed at outpatients department for 1-month, 3-months and 3-months, respectively. All the patients were assessed according to Glasgow Outcome Scale. Results: Over a period of one year; total thirty patients were selected, most of them were in the 6th and 7th decades of their lives and males were in majority 25(83%). Sixteen patients had a history of minor head injury, eleven patients had no obvious cause and one patient had chronic subdural hematoma secondary to over shunting. According to complications; intracerebral bleed was among 2(6%) cases and Pneumocephalus was in 2(6%) cases, followed by subdural empyema, acute subdural hematoma, extra dural hematoma, penetration into brain via drain catheter, C.S.F leakage and dysphasia were found in one patient, in each case, respectively. Almost every patient recovered and survival rate was 28(93%), while only two patients died. Conclusion: It was concluded that patients showed best outcome (93% survival rate) according to Glasgow Outcome Scale, after burr hole evacuation management. Head injury due to road traffic accident was the most common etiology and burr hole evacuation was the best treatment option for chronic subdural hematoma.

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