Bilateral chronic subdural hematoma: clinical presentation, outcome and review literature.

Abstract

Study design: Prospective hospital-based study. Background: Annual incidence of bilateral chronic subdural hematoma (CSDH) is increasing due to an increase in the ageing population, associated medical comorbidities such as haemodialysis, anticoagulant and/or antiplatelet therapy. Objectives: 1. To determine the socio-demographic and clinical profile of bilateral CSDH patients. 2. To determine treatment outcome and its association with the socio-demographic profile. Method: A prospective hospital-based study was carried out on 100 confirmed patients of bilateral CSDH. Information of patients such as socio-demographic profile, clinical presentation and laboratory investigation, along with treatment and outcome were recorded and analysed. Results: Among 100 patients, male and female were 74% and 26%. The mean age of patients was 63.03±13.57 years. A history of head injury was reported by 49% of patients. The mean Glasgow coma scale (GCS) was 12.14±2.38. Common presenting symptoms were hemiparesis (69%), headache (58%), aphasia (18%) and complete loss of consciousness (16%). Clinical improvement was observed in 81% while 09% had no change, 06% shows clinical deterioration and 04% of patients die during treatment. Conclusion: Bilateral CSDH is common in the elderly and prognosis is poor with increasing age however gender has no association with poor outcomes. More than 80% of patients recover with timely interventions. Key message: Surgery leads to achieving good outcomes in cases of bilateral chronic SDH, but not all such patients will recover completely. Similarly, good functional outcomes can also be achieved in those presented early after symptom onset when managed promptly.