Résumé
Objective: Chronic subdural haematoma (CSDH) is common in the elderly and is often associated with serious morbidity and mortality. Previous reports from Africa indicate earlier age of onset and a generally better tolerated condition compared with more developed countries. As the average age of the Nigerian population increases with associated medical problems, the pattern of the disease is expected to change towards that seen in more developed countries.
Methods: The study is a retrospective review of 130 patients presenting to the Memfys hospital for Neurosurgery Enugu. The demographic, causal and clinical patterns were analysed. These were compared with previous studies from Africa. 116 patients who had surgical intervention were further analysed for management and outcome.
Results: The male female ratio was 3:1 and the peak age incidence was in the 6th decade. 50.8% of cases resulted from road traffic accidents (RTA) and 21.5% from falls. Other causes included Neurosurgical procedure in 2.3%. The commonest presentations were headaches and altered consciousness. Nineteen patients were on antiplatelet drugs. Surgical treatment was with burr hole craniostomy and drainage in all cases with a perioperative mortality of 0.8%. Re-operation rate was 7.8% in all cases but 36% in patients on antiplatelet/anticoagulants. The outcome at six weeks using the Glasgow Outcome Scale (GOS) was good in 87%.
Conclusion: The pattern of CSDH in Nigeria has changed towards that seen in developed countries. There is also a general increase in frequency of the condition, and health care systems must be planned to meet this change.
Keywords: Chronic subdural haematoma, trends, change.
Résumé
L’hématome chronique subdurale (CSDH) est commun chez les vieillards et est souvent associé avec à de souffrance et la mortalité. D’autres rapports indiquent aux jeunes âges et une meilleure tolérance compare aux pays développés. Avec l’augmentation de la durée moyenne de vie de la population Nigériane avec les problèmes associés, la fréquence de la maladie est estimée a changer vers ce qui est observe dans les pays développés. Cette étude est une revue rétrospective de 130 patients se présentant à l’hôpital de Memfys, Enugu pour la neurochirurgie. La démographie, les fréquences des causes et symptômes étaient évalués et comparés a d’autres valeurs obtenues dans d’autres études en Afrique. 116 patients qui avaient eu une intervention chirurgicale étaient analyses pour nécessité des soins. La proportion male femelle était de 3:1 et l’incidence du peak d’âge était de soixante ans. 50.8% des cas résultaient des accidents de trafic routiers (ATR) et 21.5% des chutes. Autres causes inclus la procédure neurochirurgicale chez 2.3%. Les symptômes les plus communs étaient les maux de tête et les altérations de conscience Dix neuf patients étaient sous médication des antithrombocytes. Le traitement chirurgical était avec une craniotomie de troue de Burr et évacuation chez tous les cas avec une mortalité prerioperative de 0.8%. Le taux de ré-opération était de 7.8% chez tous les cas mais 36% des patients sous antiplatelet/anticoagulants. Les résultats à six semaines utilisant l’échelle de Glasgow (GOS) était bonne chez 87%. La fréquence de la CSDH au Nigeria a changé vers ce qui observe dans les pays développés. Il y a une augmentation de cette condition et les systèmes de soins de sante doivent être planifiés pour vaincre cette condition.
Correspondence: Dr. W.C. Mezue. Department of Neurosurgery, University of Nigeria Teaching Hospital, PMB 01129, Enugu, Nigeria.. E-mail: mezuec@hotmail.com
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