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

BACKGROUND: Chronic subdural haematoma (CSDH) is a common neurological condition affecting the elderly with decreased quality of life. Recurrence leads to increase in number of hospital admissions and surgical interventions. Several factors contribute to recurrence of chronic subdural haematoma, and determination of these factors will help institute measures to reduce recurrence of CSDH, cost of care and improved quality of life. The aim of this study was to determine the predictors of recurrence of chronic subdural haematoma in a cohort of patients presenting in a Sub-Saharan African Teaching Hospital. METHODS: A prospective hospital-based cohort study of 62 participants who presented with CSDH and underwent burr-hole and drainage at the Neuroscience unit of the Korle-bu Teaching Hospital. The primary outcome of this study was the recurrence of CSDH within 3 months after the surgery. Data was entered into Microsoft Excel 2016 and exported to International Business Machine (IBM) Statistical Package for the Social Sciences (SPSS) version 21.0 for analysis. Predictors of recurrence of CSDH were determined using logistic regression with odds ratio calculated at the 95% confidence level and a p-value less than 0.05 accepted as statistically significant. RESULTS: There was a male preponderance of 45 (72.6%), over females of 17 (27.4%). The mean age was 63.1 ± 13.6 years. The recurrence rate of CSDH was 21.0% whilst the mortality rate was 4.8%. Facial palsy and dysphasia were associated with the recurrence of CSDH (p = 0.045, 0.029). Hypertension and bilaterality were associated with recurrence of CSDH from a univariate analysis (p = 0.039, OR = 4.865, CI = 0.975-24.285; p = 0.005, OR = 5.979, CI = 1.585-22.557). In a multivariate logistic regression analysis, bilaterality was the only independent predictor of recurrence of CSDH (p = 0.030, AOR = 5.47, CI = 1.18-25.34). CONCLUSIONS: Both hypertension and bilaterality showed statistically significant association with recurrence of CSDH. However, only bilaterality proved to be an independent predictor of recurrence of CSDH in patient who underwent burr-hole and drainage.

Hemispheric brain abscess: a review of 46 cases.

BACKGROUND: Brain abscess is a space occupying lesion that still prevails in many developing countries but less common in developed countries. It can be a preventable cause of fatal illness if diagnosed and treated appropriately. There is little or no information of the condition in Ghana. In this review we report our experience at the Neurosurgical unit of Korle Bu Teaching Hospital (KBTH) over a four year period. STUDY DESIGN: A retrospective study of 46 patients with brain abscess(es) seen between January 1994-December 1998 was carried out at the Neurosurgical unit of KBTH, Accra, Ghana. Using hospital records of 46 patients an evaluation of computerized tomography (CT) scans of brain abscesses and the different methods of surgical treatment were made. RESULTS: 33 (72%) were male and 13 (28%) were female. 32 (70%) of the patients were aged 20 years or younger. Brain C.T. Scan was the main diagnostic imaging study performed on all the patients. In all but one case the diagnosis was a solitary abscess (98%). 38 patients (83%) had burr hole drainage under sedation and local anaesthesia and 12 under general anaesthesia. All patients were managed with appropriate antibiotics and steroids. There were 5 fatalities. CONCLUSION: Simple burr hole drainage combined with appropriate medical treatment was found to be satisfactory in managing these patients.

Chronic subdural haematoma: review of 96 cases attending the Korle Bu Teaching Hospital, Accra.

BACKGROUND: Chronic subdural haematoma is not uncommon in Africa. Early diagnosis and treatment is satisfying. Simpler operative procedures are generally effective. This review is meant to find out the situation regarding the condition in Ghana. STUDY DESIGN: A retrospective study of patients with chronic subdural haematoma admitted to and treated by the Neurosurgical Unit of Korle Bu Teaching Hospital between January 1995 and December 1998 was undertaken. The case notes, computerise axial tomography (CT) scans and operative records were reviewed and the relevant data extracted. Incomplete records were excluded. RESULTS: 96 patients were involved. The mean age of the patients was 46.9 years, with male to female ratio of 16:1. The most common presenting feature was headache (64.7%). Time of injury to presentation was about 2 months. 81 were treated using burr hole and drainage and 15 by craniotomy and stripping of membranes. Eighty four were treated under general anaesthesia. Two were reoperated on because of recurrent bleed. There were two (2) deaths. Ninety patients had a Glasgow Outcome Score of good at the time of their last review. CONCLUSION: The data suggests that burr hole and closed drainage is a very effective method of managing CSDH.