Changing trends in chronic subdural haematoma in Nigeria.
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%. 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%.


CONCLUSIONS
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.
Department of Neurosurgery, University of Nigeria Teaching Hospital, Enugu, Nigeria. mezuec@hotmail.com
W C
WC
Mezue
S C
SC
Ohaebgulam
M C
MC
Chikani
A U
AU
Erechukwu
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003399:Craniotomy / Q000379:methods*; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D020200:Hematoma, Subdural, Chronic / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D016304:Hospitals, Private; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome; D014207:Trephining; D055815:Young Adult