Clinical triad of chronic subdural haematoma

Abstract

Background: Chronic subdural haematoma (CSDH) is one of the common intracranial haemorrhages mostly affecting the elderly population. It has a great role in morbidity and mortality, yet it is treatable by relatively simple technique and the majority of patients improve rapidly following surgical intervention but mortality rate is still 13%. The incidence of CSDHs in over 65 years is 58.1 per 100,000 per year compared to 3.4 per 100,000 per year in those under 65 years of age. Most of the population in developing country like Bangladesh resides in rural area; and there is less opportunity to do Computed Tomography (CT) scan brain. So better to diagnose clinically and then confirmed by CT scan to provide necessary treatment timely to reduce suffering of the patient.The purpose of this present study was to take details history, analysis symptoms and meticulous examination to diagnose CSDHs clinically, so that further CT scan of very diagnostic cases could be done to treat properly. Materials and Method: This study was conducted in the Department of Combined Military Hospital (CMH), Dhaka from March 2018 to February 2019 and it is a prospective study. The patients more than 20 years who were admitted and diagnosed clinically and all confirmed as CSDH by non-contrast CT scan head. A total 50 patients randomly allocated and sampling was done as per inclusion and exclusion criteria but must exclude who were not CT scan positive findings. Details history, meticulous symptom imprinting, keen physical examination including neurological examination and finally data collection with CT scan-head was done. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 26 for Windows (SPSS). Results: In this study 50 cases were finally selected as ‘Chronic Subdural Haematoma’ and all were diagnosed clinically and radiologically confirmed. It was observed that most of the patients 39 (78%), 51-80 years age group. Regarding distribution of gender male were 41 & female were 9 in number. In our study subjects, it was noticed that 43(86%) subjects had trivial head trauma, on anti-platelet and anti-coagulant medication. Regarding clinical picture of these CSDHs, it was observed that less number of patients only 5 (10%) patients had hemiparesis & vomiting but 45(90%) subjects had Headache, Dysphasia and Altered level of consciousness. Conclusion: Diagnosis of CSDH by details history and meticulous clinical tests is easily accessible, less costly and effective in dubious mass population. Much suspected cases by clinical means can be confirmed by CT scan head and at least on time treatment could reduce morbidity as well as mortality of developing to poor country.