Treatment and Outcome of Chronic Subdural Hematoma in Sub-Saharan Afrcia and the Country of Benin

Abstract

Background & Aim: Chronic subdural hematoma (CSDH) is a common neurosurgical pathology. The objective of this study was to describe the epidemiology of this pathology and the results in treating it combined from three hospital centers in Benin. Methods & Materials/Patients: From September 2010 to September 2013 a multi-center, retrospective and descriptive study was conducted in three hospital centers in Benin. Inventory was taken of all patients in whom CSDH was diagnosed. Patients were evaluated according to Markwalder classification. All patients received a brain scan. The variables studied include demographic and clinical characteristics, therapeutic modalities and post-operative followup. Results: 104 consecutive patients with CSDH were included in the study. The mean age was 49.66, but ranged from six months to 87 years. The M:F sex ratio was 5.11/1. Prior cranial trauma had occurred in 81 patients (77%). Preoperative neurological Grades 1 or 2 were observed in 56.4% of cases. Surgical treatment was given to 100 patients (96.15%). Events surrounding the surgery were straightforward and results satisfactory in 94% of cases. No relapses were observed. The morbidity was 4% and the mortality among surgical patients was 3%. Conclusion: CSDH is frequently treated in the country of Benin. The mean age of patients is lower than that observed in global literature, and patients are predominantly male. Regardless of the patient condition upon hospital admission, post-operative results compare favorably with the literature.

Predictors of recurrence of chronic subdural haematoma in a cohort study of patients presenting in a sub-Saharan African teaching hospital

“…A study has attributed the lower incidence of CSDH in females to the protective effect of estrogen on capillaries and the relatively wider intracranial radius in males [ 19 ]. The male to female ratio was similar to those reported in other studies in West Africa and other parts of the world [ 4 , 16 , 20 ]. It was however different from the findings of Dakurah et al [ 17 ], in a retrospective study done 20 years ago at the same study site where a male to female ratio of 16:1 was reported.…”

“…However, the percentage of hypertensives in this study is much higher than previous studies done in west Africa. Dakurah et al had 9.7% in Accra, Bankole et al had 22.9% in Lagos, Jimoh et al had 23.3% in Zaria and Chikani et al had 15.87% in Enugu [ 16 , 17 , 20 – 23 ]. The higher percentage of hypertensives found in this study is however consistent with a recent multi-centre report from Eastern Europe which indicated that as high as 75% of patients with CSDH were hypertensives [ 24 ].…”

“…Five out of the 8 diabetics also had a history of hypertension. The frequency of participants with a history of diabetes in this study is one of the highest in West Africa [ 16 ]. The prevalence of diabetes mellitus amongst patients reporting with CSDH is less than 10%.…”

“…Using 80% power and 10% attrition, a sample size of 62 was obtained considering the calculated mean of 3.6% for the West African sub-region and an expected higher recurrence rate for KBTH, 20 years after the study by Dakurah et al [ 16 , 17 ].…”

Chronic subdural hematomas: a case series from the medical ward of a north Tanzanian referral hospital

“…Generally, a younger cohort is observed, and it is thought that this may be due to the increased incidence of trauma in the region as well as a lower life expectancy compared to the higher-income countries [6,7,10]. The challenges of accessibility to diagnostic imaging services, due to financial constraints or more simply availability, have also been discussed in African literature [12,13]. The availability of neurosurgical expertise on the continent is far below that required to meet the demand; in some African countries, successful treatment of this intracranial bleed is carried out by general surgeons [14].…”