Chronic Subdural Hematoma Treatment in Delhi
Chronic subdural haematoma (chronic SDH) is a neurological condition in which blood and degraded blood products get accumulated between the membrane of the brain, duramater, and arachnoid and pial covered brain surface.
KEY EPIDEMIOLOGIC FEATURES
- Incidence in India is estimated to be 2 to 8 per 100000 population.
- Generally it is considered to be a disease of 70 years and above but in india, age peak is a bit lower , around 60 years of age.
- Male:Female ratio is around 3:1
- Common risk factors include oral intake of antiplatelets or anticoagulants and alcoholism among others.
CLINICAL MANIFESTATIONS IN CHRONIC SDH
Chronic SDH is one of the most satisfying diagnoses to catch. A case, if detected early, is potentially reversible and curable. It is important to realize that it is frequently misdiagnosed as clinical presentation is generally insidious, takes more than typically 3 to 4 weeks, to develop. 60-70% cases have progressive mental changes, often categorized as dementia or other neurocognitive disorder. Pseudo dementia with rapid onset of forgetfulness, confusion and disorientation is quite common. Headache is another symptom to watch out for. It’s usually dull, generalized and persistent and may be associated with papilledema and vomiting. Focal neurological deficits such as hemiparaesis (weakness of one side of the body), ataxia (difficulty in walking) and aphasia (difficulty in speaking) can also be among the presenting features. It is very important to note that many times, the trauma is often trivial and goes unnoticed by the patients and relatives. Latent phase of 2 – 6 weeks between the trauma and onset of symptoms often confuses the diagnosis and contributes towards late presentation to a neurosurgeon.
Related Treatments
- Brain Tumor Surgery
- Neuro Infections
- Spine Disorders
- Cerebral Palsy
- Dementia Treatment
- Stroke Paralysis
- Brain Hemorrhage Treatment
- Parkinson’s Disease
- Dementia Treatment
TREATMENT OF CHRONIC SDH
Treatment of chronic SDH is primarily surgical. However, medical management and observation can be done if
- Patients GCS is 15 AND
- There is no focal neurological deficit AND
- Absence of seizures AND
- Clot thickness is less than 10 mm AND
- Midline shift is less than 5 mm AND
- Significant effacement of gyri and sulci signifying brain compression.
Where surgery is indicated, generally a 2 burr hole surgery for clot evacuation is recommended. This can be expanded to a mini craniotomy in cases where the clot is thicker. Endsocopic mini craniotomy and removal of haematoma and standalone middle meningeal artery embolization are novel approaches that are employed for management of chronic subdural haematoma. In general, if a patient with chronic SDH does not seem “like himself”, its probably fit for surgical evacuation.