Impact on Cognitive Improvement Following Burr Hole Evacuation of Chronic Subdural Hematoma: A Prospective Observational Study

Abstract

Objective:Patients of Chronic subdural haematoma can present with only subtle cognitive impairment without any motor deficit. It is hence imperative for the treating clinician to be aware of this entity. The aim of the study was to identify any statistically significant improvement of cognitive functions following burr hole evacuation of Chronic SDH especially in the elderly patients.Methods and Material:A Prospective observational study of 30 patients of CSDH, from Jan 2015 to Dec 2016 was done at a tertiary level Armed Forces Hospital. The study had 23 male, 07 female, with age ranging from 7-85 years. The cognitive function of each patient was assessed at admission and 24 hours after surgery by MMSE. Radiological confirmation was done by CT head. Standard two burr holes were made and hematoma evacuated. The clinical, cognitive assessment and radiological data were collected and analysed.Results:There was no statistical significance preoperatively between age and pre operative cognitive impairment, headache, hemiparesis, dysarthria (P>0.05). We however found a statistically significant improvement postoperatively in cognitive impairment, headache (P= 0.00), motor deficit (P=0.01) and dysarthria (P=0.046).Conclusion:The clinical features of dementia and other neurodegenerative disorders simulate CSDH in the geriatric population. These patients should have early neuroimaging and prompt surgical intervention to alleviate cognitive deficits.

Prevalence of Cognitive Complaints and Impairment in Patients with Chronic Subdural Hematoma and Recovery after Treatment: A Systematic Review

“…Of the remaining 22 articles, 16 reported only on the prevalence of CC/CI in CSDH patients, 4,6,23-36 and 6 reported on the pre-treatment prevalence and the improvement of CC/CI after treatment. 12,[37][38][39][40][41] Five of these six articles also reported on prevalence of CC/CI, making a total of 21 articles that reported on prevalence of CC/CI. Of these 21 articles, 16 retrospectively studied their patients, and 5 had a prospective design.…”

“…Cognitive status was measured with only the MMSE in two studies, 12,41 with only the RBMT in one, 39 and with the MMSE and HDS-R in another one. 40 In most other studies types of CI or CCs varied and lacked clear definitions.…”

“…Of the six included studies that assessed cognition after treatment, two were retrospective cohort studies, 37,38 and four had a prospective design (Table 3). 12,[39][40][41] All studies reported on surgically treated patients of whom the vast majority was treated with BHC. Hence there were no patients who received drug therapy or non-interventional treatment.…”

“…Three of the prospective studies reported on the time between surgery and cognitive testing. [39][40][41]…”

“…Pre-operative MMSE score differed from 16 to 23, which improved to 20-27 after surgery. 40,41 Postoperative tests were performed between 24 h and 2 weeks after surgery. Pre-operative MMSE scores <24 were reported in 54-69% of patients.…”