Changing trends in chronic subdural haeniatoma in Nigeria

Abstract

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 compare d 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 analyzed. These were compared with previous studies from Africa. 116 patients who had surgical intervention were further analyzed for management and outcome. Results: The male female ratio was 3:1 and the peak age incidence was in the 6"' 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%. Reoperation 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.