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Abstract
ABSTRACT
Introduction:
Non-traumatic subdural hematoma (SDH) is a rare but grave complication of hemodialysis (HD). Recent data suggests the annual incidence has doubled in the last decade in the USA. With geographic variations in epidemiologic profile of the maintenance HD population, we sought to study the pattern of non-traumatic SDH in a Sub-Saharan African hemodialysis setting.
Methodology
We conducted a retrospective review of medical records of patients treated by maintenance hemodialysis diagnosed by brain CT scan at the Hemodialysis unit of the Yaoundé General Hospital from November 2002 to November 2012 to identify patients with non-traumatic subdural hematoma occurring after a period of at least 90 days on maintenance HD. Relevant data was collected for analysis.
Results
A total of two cases of non-traumatic SDH were identified from the 464 patient records (cumulative incidence of 0.43% in 10 years). These were males with end stage renal disease from malignant nephrosclerosis. The mean age was 52 years. None was receiving prophylactic anti-thrombotic agents. Headaches and neurological deficits were the main clinical features. Treatment was surgical with a mortality rate of 50%. Large interdialytic weight gain, excessive ultrafiltrates and uncontrolled hypertension were common findings.
Conclusion
The frequency, clinical presentation, and prognosis of non-traumatic SDH are similar to studies in Europe and the USA. However, contrary to the later, non-traumatic SDH occurs in young males not on prophylactic antithrombotic agents in our setting. Early diagnosis through a high index of suspicion and access to CT scan may reduce diagnostic delays and improve outcome.
Key words: non-traumatic subdural hematoma, hemodialysis, management, outcome
RESUME
Introduction
L’hématome sous-dural (HSD) non-traumatique est une complication rare et grave de l’hémodialyse chronique (HDC). Les données récentes suggèrent que l’incidence annuelle a doublé au cours de la dernière décennie aux Etats Unis. Avec la différence des caractéristiques des hémodialysés chroniques, nous avons entrepris d’étudier le profil de l’HSD non-traumatique en Afrique Sub-Saharienne.
Méthodologie
Il s’agissait d’une analyse rétrospective des dossiers médicaux d’hémodialysés chroniques depuis au moins trois mois, ayant présenté un HSD non-traumatique diagnostiqué au scanner cérébral dans l’unité d’hémodialyse de l’Hôpital Général de Yaoundé pendant la période allant de Novembre 2002 à Novembre 2012. Les données cliniques importantes étaient relevées.
Résultats
Sur 464 dossiers médicaux recensés, deux cas d’HSD non-traumatique ont été identifiés, soit une incidence cumulative de 0,43% en 10 ans. Il s’agissait des sujets de sexe masculin, d’âge moyen de 52 ans, en insuffisance rénale chronique terminale secondaire à une hypertension artérielle maligne, ne recevant aucune prophylaxie anti-thrombotique et présentant des céphalées associées aux déficits neurologiques. Le traitement était chirurgical avec un taux mortalité de 50%. La prise importante de poids interdialytique, l’ultrafiltration excessive et l’hypertension artérielle non contrôlée étaient les principales trouvailles cliniques.
Conclusion
La fréquence, la présentation clinique et le pronostic de l’HSD non-traumatique reportés dans cette étude sont similaires aux données européennes et américaines. Cependant, dans notre série, HSD non-traumatique survient chez des sujets jeunes, en absence de traitement anti-thrombotique prophylactique. Le diagnostic précoce par une suspicion clinique et l’accès au scanner cérébral pourraient améliorer leur pronostic.
Mots clés : hématome sous-dural non-traumatique, hémodialyse, traitement, pronostic.
Keywords
Article Details
References
- Leonard A, Shapiro FL. Subdural hematoma in regularly hemodialyzed patients. Ann Intern Med. 1975 May;82(5):650–8.
- Bechar M, Lakke JP, van der Hem GK, Beks JW, Penning L. Subdural hematoma during long-term hemodialysis. Arch Neurol. 1972 Jun;26(6):513–6.
- Sood P, Sinson GP, Cohen EP. Subdural hematomas in chronic dialysis patients: significant and increasing. Clin J Am Soc Nephrol CJASN. 2007 Sep;2(5):956–9.
- Power A, Hamady M, Singh S, Ashby D, Taube D, Duncan N. High but stable incidence of subdural haematoma in haemodialysis--a single-centre study. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2010 Jul;25(7):2272–5.
- Stefanidis I, Bach R, Mertens PR, Liakopoulos V, Liapi G, Mann H, et al. Influence of hemodialysis on the mean blood flow velocity in the middle cerebral artery. Clin Nephrol. 2005 Aug;64(2):129–37.
- Hata R, Matsumoto M, Handa N, Terakawa H, Sugitani Y, Kamada T. Effects of hemodialysis on cerebral circulation evaluated by transcranial Doppler ultrasonography. Stroke J Cereb Circ. 1994 Feb;25(2):408–12.
- Bennett WM. Should dialysis patients ever receive warfarin and for what reasons? Clin J Am Soc Nephrol CJASN. 2006 Nov;1(6):1357–9.
- Naicker S. Burden of end-stage renal disease in sub-Saharan Africa. Clin Nephrol. 2010 Nov;74 Suppl 1:S13–16.
- Kaze FF, Ashuntantang G, Kengne AP, Hassan A, Halle MP, Muna W. Acute hemodialysis complications in end-stage renal disease patients: the burden and implications for the under-resourced Sub-Saharan African health systems. Hemodial Int Int Symp Home Hemodial. 2012 Oct;16(4):526–31.
- Bello BT, Raji YR, Sanusi I, Braimoh RW, Amira OC, Mabayoje OM. Challenges of providing maintenance hemodialysis in a resource poor country: Experience from a single teaching hospital in Lagos, Southwest Nigeria. Hemodial Int Int Symp Home Hemodial. 2013 Jul;17(3):427–33.
- Fokou M, Teyang A, Ashuntantang G, Kaze F, Eyenga VC, Chichom Mefire A, et al. Complications of arteriovenous fistula for hemodialysis: an 8-year study. Ann Vasc Surg. 2012 Jul;26(5):680–4.
- Ashuntantang GE, Njouom R, Kengne AP, Ngemhe AN, Kaze FF, Luma HN, et al. Incidence and potential risk factors for seroconversion to Hepatitis C positivity in patients on Maintenance Hemodialysis in Sub-Saharan Africa: A single center study. Health Sci Dis [Internet]. 2013 [cited 2014 Jan 24];14(1). Available from: http://www.hsd-fmsb.org/index.php/hsd/article/view/74
- Bower JH, Zenebe G. Neurologic services in the nations of Africa. Neurology. 2005 Feb 8;64(3):412–5.
- Dongmo L, Juimo A, Eloundou N, Njamnshi A, Adeeva V, Tiyou C. [Hematome sous-dural chronique au Cameroun: Aspects cliniques, radiologiques et thérapeutiques a propos de 43 cas]. Médecine Afr Noire. 1999;46(3):157–60.
- Nakashima H, Tomita S, Yoshino K, Norikane H, Baba Y, Doi A, et al. [A case of chronic subdural hematoma in a hemodialyzed patient]. No Shinkei Geka. 1986 Apr;14(5):675–9.
- Inzelberg R, Neufeld MY, Reider I, Gari P. Non surgical treatment of subdural hematoma in a hemodialysis patient. Clin Neurol Neurosurg. 1989;91(1):85–9.
- Tietjen DP, Moore J Jr, Gouge SF. Hemodialysis-associated acute subdural hematoma. Interim management with peritoneal dialysis. Am J Nephrol. 1987;7(6):478–81.
- Djientcheu V, Esiene A, Yamgoue T, Tchaleu B, Minkande JZ. Surgical treatment and outcome of 195 cases of non acute subdural haematoma at the Youndé Central Hospital: The need for landmarked burr holes. Afr J Neurol Sci [Internet]. 2011 [cited 2014 Jan 24];30(2). Available from: http://www.ajol.info/index.php/ajns/article/view/77314
- Vujkovac B, Sabovic M. Treatment of subdural and intracerebral haematomas in a haemodialysis patient with tranexamic acid. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2000 Jan;15(1):107–9.
References
Leonard A, Shapiro FL. Subdural hematoma in regularly hemodialyzed patients. Ann Intern Med. 1975 May;82(5):650–8.
Bechar M, Lakke JP, van der Hem GK, Beks JW, Penning L. Subdural hematoma during long-term hemodialysis. Arch Neurol. 1972 Jun;26(6):513–6.
Sood P, Sinson GP, Cohen EP. Subdural hematomas in chronic dialysis patients: significant and increasing. Clin J Am Soc Nephrol CJASN. 2007 Sep;2(5):956–9.
Power A, Hamady M, Singh S, Ashby D, Taube D, Duncan N. High but stable incidence of subdural haematoma in haemodialysis--a single-centre study. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2010 Jul;25(7):2272–5.
Stefanidis I, Bach R, Mertens PR, Liakopoulos V, Liapi G, Mann H, et al. Influence of hemodialysis on the mean blood flow velocity in the middle cerebral artery. Clin Nephrol. 2005 Aug;64(2):129–37.
Hata R, Matsumoto M, Handa N, Terakawa H, Sugitani Y, Kamada T. Effects of hemodialysis on cerebral circulation evaluated by transcranial Doppler ultrasonography. Stroke J Cereb Circ. 1994 Feb;25(2):408–12.
Bennett WM. Should dialysis patients ever receive warfarin and for what reasons? Clin J Am Soc Nephrol CJASN. 2006 Nov;1(6):1357–9.
Naicker S. Burden of end-stage renal disease in sub-Saharan Africa. Clin Nephrol. 2010 Nov;74 Suppl 1:S13–16.
Kaze FF, Ashuntantang G, Kengne AP, Hassan A, Halle MP, Muna W. Acute hemodialysis complications in end-stage renal disease patients: the burden and implications for the under-resourced Sub-Saharan African health systems. Hemodial Int Int Symp Home Hemodial. 2012 Oct;16(4):526–31.
Bello BT, Raji YR, Sanusi I, Braimoh RW, Amira OC, Mabayoje OM. Challenges of providing maintenance hemodialysis in a resource poor country: Experience from a single teaching hospital in Lagos, Southwest Nigeria. Hemodial Int Int Symp Home Hemodial. 2013 Jul;17(3):427–33.
Fokou M, Teyang A, Ashuntantang G, Kaze F, Eyenga VC, Chichom Mefire A, et al. Complications of arteriovenous fistula for hemodialysis: an 8-year study. Ann Vasc Surg. 2012 Jul;26(5):680–4.
Ashuntantang GE, Njouom R, Kengne AP, Ngemhe AN, Kaze FF, Luma HN, et al. Incidence and potential risk factors for seroconversion to Hepatitis C positivity in patients on Maintenance Hemodialysis in Sub-Saharan Africa: A single center study. Health Sci Dis [Internet]. 2013 [cited 2014 Jan 24];14(1). Available from: http://www.hsd-fmsb.org/index.php/hsd/article/view/74
Bower JH, Zenebe G. Neurologic services in the nations of Africa. Neurology. 2005 Feb 8;64(3):412–5.
Dongmo L, Juimo A, Eloundou N, Njamnshi A, Adeeva V, Tiyou C. [Hematome sous-dural chronique au Cameroun: Aspects cliniques, radiologiques et thérapeutiques a propos de 43 cas]. Médecine Afr Noire. 1999;46(3):157–60.
Nakashima H, Tomita S, Yoshino K, Norikane H, Baba Y, Doi A, et al. [A case of chronic subdural hematoma in a hemodialyzed patient]. No Shinkei Geka. 1986 Apr;14(5):675–9.
Inzelberg R, Neufeld MY, Reider I, Gari P. Non surgical treatment of subdural hematoma in a hemodialysis patient. Clin Neurol Neurosurg. 1989;91(1):85–9.
Tietjen DP, Moore J Jr, Gouge SF. Hemodialysis-associated acute subdural hematoma. Interim management with peritoneal dialysis. Am J Nephrol. 1987;7(6):478–81.
Djientcheu V, Esiene A, Yamgoue T, Tchaleu B, Minkande JZ. Surgical treatment and outcome of 195 cases of non acute subdural haematoma at the Youndé Central Hospital: The need for landmarked burr holes. Afr J Neurol Sci [Internet]. 2011 [cited 2014 Jan 24];30(2). Available from: http://www.ajol.info/index.php/ajns/article/view/77314
Vujkovac B, Sabovic M. Treatment of subdural and intracerebral haematomas in a haemodialysis patient with tranexamic acid. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2000 Jan;15(1):107–9.