Management and Outcome of Chronic Subdural Hematoma: A Prospective Study of Shaikh Zayed Hospital, Lahore
Background/Objective: Chronic subdural hematoma (CSH) is a type of intracranial hemorrhage is commonly seen in old age. It has a poor prognosis when misdiagnosed or a delayed treatment can lead to significant morbidity. We evaluated the effectiveness of available surgical treatments for the management and outcome of CSH.
Method: The prospective cases (n = 48) of CSH were included from Department of Neurosurgery, Sheikh Zayed Hospital, Lahore during January 2014- December 2017. Detailed history of patients was taken along with comprehensive examinations with CT scans and MRIs. The CSH patients were treated surgically either with burr-hole evacuation (unilateral/bilateral) with irrigation or burr-hole drainage with drain 48 to 72 hours.
Results: The mean age of male patients was 68 years and 56 years in female patients. Most of our patients recovered (81.25%; GOS 5) uneventfully. Patients were mostly treated with burr-hole evacuation with irrigation. The 15% patients had required ICU management with GOS 2-3. Older (> 65 years) male patients were at higher risk of CSH. Trauma was not the only major cause of the CSH as history of trauma was not present in the majority (< 25%) of the patients. We found following significant risk factors, i.e., hypertension (73%), DM (62.5%) and ischemic heart disease (60%) and intake of anticoagulant/antiplatelet drugs (60%). A 4% recurrence was reported in our CSH patients. Stroke as a postoperative complication was reported in two patients (4%) and only one patient (2%) died of aspiration pneumonia.
Conclusion: Chronic subdural hematoma can be effectively treated by simple surgical intervention if diagnosed early and mortality can be reduced. We found burr-hole evacuation (unilateral/bilateral) with irrigation an effective treatment against CSH, as most of our patients (> 80%) were recovered with it. The trauma was not the only cause of CSH as history of trauma was not present in the majority of the patients, therefore, some other factors are also involved in the CSH formation in old age.
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