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Abstract
Objective. Chronic subdural hematoma (CSDH) is common neurosurgical pathology. The authors conducted a study to describe, the epidemiology and the management of CSDH, in a low- and middle-income countrie. Materials and methods. The study was performed at Centre Hospitalier Universitaire Sylvanus Olympio of Lomé (Togo), between november 2017 and december 2018. After approval of the ethics committee of the hospital, patients of any age who presented and were diagnosed with CSDH during the period of the study were included. Variables were collected from patients’ files at discharge and follow-up clinic visits. Results. Sixty patients, the majority were male (81.8%, 54/66) were enrolled in the study. The sex ratio was 4.5:1. The mean age was 53.91 ± 16.65 years. Prior cranial trauma was identified in 55 patients (83.3%). Limb weakness was the most common presenting symptom (56.1%, 37/66) followed by headache (51.4%, 34/66), and confusion (34.8%, 23/66). All patients underwent surgery. The morbidity was 1.52% and the mortality among surgery was 1.52%. Conclusion. Trauma was a common cause of CSDH among younger men patients. Burr-hole surgery with closed drainage was a safe procedure in the treatment of CSDH.
RÉSUMÉ
Introduction. Le but de cette étude était d’évaluer la prise en charge des patients ayant un hématome sous-dural chronique. Patients et méthodes. Il s’agit d’une étude descriptive monocentrique de novembre 2017 à décembre 2018, au CHU rétrospective et analytique des dossiers des patients hospitalisés pour un hématome sous-dural chronique, dans le service de Neurochirurgie du CHU SO de Lomé. Résultats. Soixante-six patients dont 81,8% étaient des hommes, répondaient aux critères d’inclusion. L’âge moyen de la série était de 53,91 ± 16,65 ans. Le traumatisme crânien représentait la principale étiologie (83,3% des cas). Les principaux symptômes à l’admission étaient le déficit de membres (56,1%), suivi des céphalées (51,4%) et de la confusion (34,8%). Tous les patients de la série ont été opérés. La mortalité globale était de 1,52%. Conclusion. Le traumatisme crânien est la principale étiologie des hématomes sous-duraux chroniques chez des patients jeunes. La chirurgie constitue le traitement efficace de ces hématomes.
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References
- - Jones S, Kafetz K: A prospective study of chronic subdural haematomas in elderly patients. Age Ageing.1999 Oct;28(6):519-21
- - Kerabe S, Ozawa T, Watanabe T, Atoa T: Efficacy and safety of post-operative early mobilization for chronic subdural haematoma in elderly patients. Acta Neurochir (Wien). 2010;152:1171–1174
- - Ducruet AF, Grobelny BT, Zacharia BE, Hickman ZL, DeRosa PL, Anderson K, et al. The surgical management of chronic subdural hematoma. Neurosurg Rev. 2012;35(2):155-69; discussion 69.
- - Gelabert-Gonzalez M, Iglesias-Pais M, Garcia-Allut A, Martinez-Rumbo R. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clinical neurology and neurosurgery.2005 Apr;107(3):223-9
- - Adeolu AA, Rabiu TB, Adeleye AO: Post-operative day two versus day seven mobilization after burr-hole drainage of subacute and chronic subdural haematoma in Nigerians. Br J Neurosurg.2012 Oct ;26(5):743–746
- - Dakurah T, Iddrissu M, Wepeba G, Nuamah I: Chronic subdural haematoma: review of 96 cases attending the Korle Bu, Teaching Hospital, Accra.West Afr J Med.2005 Oct-Dec ;24(4):283–286
- - Mezue WC, Ohaebgulam SC, Chikani MC, Erechukwu AU: Changing trends in chronic subdural haematoma in Nigeria. Afr J Med Med Sci.2011 Dec;40(4):373–376
- - Kitya D, Punchak M, Abdelgadir J, Obiga O, Harborne D, Haglund MM: Causes, clinical presentation, management, and outcomes of chronic subdural hematoma at Mbarara Regional Referral Hospital. Neurosurg Focus.2018 Oct ;45(4):E7.
- - World Bank. Togo: Country at a glance: http://www.worldbank.org/en/country/togo; 2019 [march 21, 2019].
- - Markwalder TM. Chronic subdural haematoma: A review. Journal of neurosurgery.1981 May;54(5):637-45.
- - Contini S: Surgery in developing countries: why and how to meet surgical needs worldwide. Acta Biomed.2007;78(1):4–5
- - Idro R: Acquired brain injury in children in Sub-Saharan Africa, in Musisi S, Jacobson S (eds): Brain Degeneration and Dementia in Sub-Saharan Africa. New York: Springer Science.2015;183–199
- - Miranda LB, Braxton E, Hobbs J, Quigley MR: Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg.2011 Jan ;(1):72–76
- - Djientcheu V. P. EA, Yamgoue T., Tchaleu B., Ze Minkande J. Surgical treatment and outcome of 195 cases of non acute subdural haematoma at the yaoundé central hospital: the need for landmarked burr holes. AJNS. 2011;30(2):19-27
- - Mwanyombet Ompounga L., Ada Loembe F.C., Loembe P.M. Traitement des hématomes sousduraux chroniques à Libreville (Gabon) : revue de 102 cas. AJNS. 2011;30(2):28-38
- - Hode L, Quenum K, Fatigba O.H, Fanou L, Lansdale G.S.H. Treatment and Outcome of Chronic Subdural Hematoma in Sub-Saharan Africa and the Country of Benin. IrJNS. 2015;1(2):31-35
- - Bankole O B YAS, Kanu O O, Ukponmwan E N M N, Arigbabu S O. chronic subdural haematoma: clinical presentation, surgical treatment and outcome at the lagos university teaching hospital. AJNS. 2011;30(1):10-7
- - Hima-Maiga A. SY, Ndoye N., Ba M.C., Diallo M., Badiane S.B. Chronic subdural hematomas in Dakar: clinical, diagnostic, therapeutic and evolving features in the age of the scanner (a propos of 88 cases). Mali Med. 2008;23(4):11-6
- - Baechli H NA, Bucher HC, Gratzl O. Demographics and prevalent risk factors of chronic subdural haematoma: results of a large singlecenter cohort study. Neurosurg Rev. 2004;27(4):263–6
- - Fogelholm R, Heiskanen O, Waltimo O: Chronic subdural hematoma in adults. Influence of patient’s age on symptoms, signs, and thickness of hematoma. J Neurosurg.1975 Jan;42(1):43–46
- - Nayil K, Ramzan A, Sajad A, Zahoor S, Wani A, Nizami F, et al. Subdural hematomas: an analysis of 1181 Kashmiri patients. World Neurosurg. 2012;77(1):103-10.
- - Sousa EB, Brandao LF, Tavares CB, Borges IB, Neto NG, Kessler IM. Epidemiological characteristics of 778 patients who underwent surgical drainage of chronic subdural hematomas in Brasilia, Brazil. BMC surgery. 2013;13:5.
- - Kolias AG, Chari A, Santarius T, Hutchinson PJ: Chronic subdural haematoma: modern management and emerging therapies. Nat Rev Neurol.2014 Oct;10(10):570–578
- - Mellergrad P, Wisten O: Operations and re-operations for chronic subdural haematoma during a 25 year period in a well-defined population. Acta Neurochir.1996;138:708–713
- - Traynelis VC: Chronic subdural hematoma in the elderly. Clin Geriatr Med.1991 Aug ;7(3):583–598
- - Dudoit T, Labeyrie PE, Deryckere S, Emery E, Gaberel T. Is systematic post-operative CT scan indicated after chronic subdural hematoma surgery? A case–control study.
- Acta Neurochir (Wien).2016 Jul ;158 (7), 1241-1246
- - Rovlias A, Theodoropoulos S, Papoutsakis D: Chronic subdural hematoma: surgical management and outcome in 986 cases: a classification and regression tree approach. Surg Neurol Int.2015 Jul 30 ;6:127
- - Akbar A: Myelography in spinal disorders—experience of 1400 cases. J Pak Med Assoc.2004 ;54:604–609
- - Park BE: Surgical treatment of degenerative lumbar spine disease in rural Sub-Saharan Africa: a retrospective study of 450 cases and its future implications. World Neurosurg.2016 Mar;87:417–421
- - Abdulla AJ, Pearce VR: Reversible akinetic-rigid syndrome due to bilateral subdural haematomas. Age Ageing.1999;28:582–583
- - Adhiyaman V, Asghar M, Ganeshram KN, Bhowmick BK: Chronic subdural haematoma in the elderly. Postgrad Med J.2002 Feb;78(916):71–75
- - Kudo H, Kuwamura K, Izawa I, Sawa H, Tamaki N: Chronic subdural hematoma in elderly people: present status on Awaji Island and epidemiological prospect. Neurol Med Chir (Tokyo).1992 Apr ;32(4):207–209
- - Potter JF, Fruin AH: Chronic subdural hematoma—the “great imitator”. Geriatrics. 1977 ;32:61–66
- - Sunada I, Inoue T, Tamura K, Akano Y, Fu Y: Parkinsonism due to chronic subdural hematoma. Neurol Med Chir (Tokyo).1996;36:99–101
References
- Jones S, Kafetz K: A prospective study of chronic subdural haematomas in elderly patients. Age Ageing.1999 Oct;28(6):519-21
- Kerabe S, Ozawa T, Watanabe T, Atoa T: Efficacy and safety of post-operative early mobilization for chronic subdural haematoma in elderly patients. Acta Neurochir (Wien). 2010;152:1171–1174
- Ducruet AF, Grobelny BT, Zacharia BE, Hickman ZL, DeRosa PL, Anderson K, et al. The surgical management of chronic subdural hematoma. Neurosurg Rev. 2012;35(2):155-69; discussion 69.
- Gelabert-Gonzalez M, Iglesias-Pais M, Garcia-Allut A, Martinez-Rumbo R. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clinical neurology and neurosurgery.2005 Apr;107(3):223-9
- Adeolu AA, Rabiu TB, Adeleye AO: Post-operative day two versus day seven mobilization after burr-hole drainage of subacute and chronic subdural haematoma in Nigerians. Br J Neurosurg.2012 Oct ;26(5):743–746
- Dakurah T, Iddrissu M, Wepeba G, Nuamah I: Chronic subdural haematoma: review of 96 cases attending the Korle Bu, Teaching Hospital, Accra.West Afr J Med.2005 Oct-Dec ;24(4):283–286
- Mezue WC, Ohaebgulam SC, Chikani MC, Erechukwu AU: Changing trends in chronic subdural haematoma in Nigeria. Afr J Med Med Sci.2011 Dec;40(4):373–376
- Kitya D, Punchak M, Abdelgadir J, Obiga O, Harborne D, Haglund MM: Causes, clinical presentation, management, and outcomes of chronic subdural hematoma at Mbarara Regional Referral Hospital. Neurosurg Focus.2018 Oct ;45(4):E7.
- World Bank. Togo: Country at a glance: http://www.worldbank.org/en/country/togo; 2019 [march 21, 2019].
- Markwalder TM. Chronic subdural haematoma: A review. Journal of neurosurgery.1981 May;54(5):637-45.
- Contini S: Surgery in developing countries: why and how to meet surgical needs worldwide. Acta Biomed.2007;78(1):4–5
- Idro R: Acquired brain injury in children in Sub-Saharan Africa, in Musisi S, Jacobson S (eds): Brain Degeneration and Dementia in Sub-Saharan Africa. New York: Springer Science.2015;183–199
- Miranda LB, Braxton E, Hobbs J, Quigley MR: Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg.2011 Jan ;(1):72–76
- Djientcheu V. P. EA, Yamgoue T., Tchaleu B., Ze Minkande J. Surgical treatment and outcome of 195 cases of non acute subdural haematoma at the yaoundé central hospital: the need for landmarked burr holes. AJNS. 2011;30(2):19-27
- Mwanyombet Ompounga L., Ada Loembe F.C., Loembe P.M. Traitement des hématomes sousduraux chroniques à Libreville (Gabon) : revue de 102 cas. AJNS. 2011;30(2):28-38
- Hode L, Quenum K, Fatigba O.H, Fanou L, Lansdale G.S.H. Treatment and Outcome of Chronic Subdural Hematoma in Sub-Saharan Africa and the Country of Benin. IrJNS. 2015;1(2):31-35
- Bankole O B YAS, Kanu O O, Ukponmwan E N M N, Arigbabu S O. chronic subdural haematoma: clinical presentation, surgical treatment and outcome at the lagos university teaching hospital. AJNS. 2011;30(1):10-7
- Hima-Maiga A. SY, Ndoye N., Ba M.C., Diallo M., Badiane S.B. Chronic subdural hematomas in Dakar: clinical, diagnostic, therapeutic and evolving features in the age of the scanner (a propos of 88 cases). Mali Med. 2008;23(4):11-6
- Baechli H NA, Bucher HC, Gratzl O. Demographics and prevalent risk factors of chronic subdural haematoma: results of a large singlecenter cohort study. Neurosurg Rev. 2004;27(4):263–6
- Fogelholm R, Heiskanen O, Waltimo O: Chronic subdural hematoma in adults. Influence of patient’s age on symptoms, signs, and thickness of hematoma. J Neurosurg.1975 Jan;42(1):43–46
- Nayil K, Ramzan A, Sajad A, Zahoor S, Wani A, Nizami F, et al. Subdural hematomas: an analysis of 1181 Kashmiri patients. World Neurosurg. 2012;77(1):103-10.
- Sousa EB, Brandao LF, Tavares CB, Borges IB, Neto NG, Kessler IM. Epidemiological characteristics of 778 patients who underwent surgical drainage of chronic subdural hematomas in Brasilia, Brazil. BMC surgery. 2013;13:5.
- Kolias AG, Chari A, Santarius T, Hutchinson PJ: Chronic subdural haematoma: modern management and emerging therapies. Nat Rev Neurol.2014 Oct;10(10):570–578
- Mellergrad P, Wisten O: Operations and re-operations for chronic subdural haematoma during a 25 year period in a well-defined population. Acta Neurochir.1996;138:708–713
- Traynelis VC: Chronic subdural hematoma in the elderly. Clin Geriatr Med.1991 Aug ;7(3):583–598
- Dudoit T, Labeyrie PE, Deryckere S, Emery E, Gaberel T. Is systematic post-operative CT scan indicated after chronic subdural hematoma surgery? A case–control study.
Acta Neurochir (Wien).2016 Jul ;158 (7), 1241-1246
- Rovlias A, Theodoropoulos S, Papoutsakis D: Chronic subdural hematoma: surgical management and outcome in 986 cases: a classification and regression tree approach. Surg Neurol Int.2015 Jul 30 ;6:127
- Akbar A: Myelography in spinal disorders—experience of 1400 cases. J Pak Med Assoc.2004 ;54:604–609
- Park BE: Surgical treatment of degenerative lumbar spine disease in rural Sub-Saharan Africa: a retrospective study of 450 cases and its future implications. World Neurosurg.2016 Mar;87:417–421
- Abdulla AJ, Pearce VR: Reversible akinetic-rigid syndrome due to bilateral subdural haematomas. Age Ageing.1999;28:582–583
- Adhiyaman V, Asghar M, Ganeshram KN, Bhowmick BK: Chronic subdural haematoma in the elderly. Postgrad Med J.2002 Feb;78(916):71–75
- Kudo H, Kuwamura K, Izawa I, Sawa H, Tamaki N: Chronic subdural hematoma in elderly people: present status on Awaji Island and epidemiological prospect. Neurol Med Chir (Tokyo).1992 Apr ;32(4):207–209
- Potter JF, Fruin AH: Chronic subdural hematoma—the “great imitator”. Geriatrics. 1977 ;32:61–66
- Sunada I, Inoue T, Tamura K, Akano Y, Fu Y: Parkinsonism due to chronic subdural hematoma. Neurol Med Chir (Tokyo).1996;36:99–101