Chronic Subdural Hematoma: Our Experience in Tertiary Care Centre

Aim and Objectives: Chronic subdural hematoma is one of the most commonly seen neurological disorders. The purpose of this study is to analyse the chronic SDH patients in tertiary care centre and to correlate association of cardiac diseases and radiological types with recurrence. Methods: This is a retrospective observational study of 150 consecutive patients with chronic SDH admitted at Institute of Neurosurgery, Rajiv Gandhi Government General Hospital during 3 years period from 2019 to 2022. The data were obtained from medical records which include demographic features, clinical presentations, prior trauma history, associated comorbid illnesses, anticoagulants history, radiological features, surgical options, recurrence, complications and outcome. All patients with chronic SDH irrespective of the age were included in this study. Results: The collected data were analysed with IBM SPSS Statistics software. In this study age group 41 - 60 years were predominant (n=69, 46%) and male preponderance with male: femaleratio of 3.4: 1. The most common clinical symptom observed was headache (n=130, 86%) followed by limb weakness (n=113, 75%).89 patients admitted with GCS 15 (60%), 47 patients with GCS 9 to 14 (31%), 14 patients with GCS less than 8 (9%). History of prior head trauma including trivial injuries was present in 88% of patients (n=133). Comorbid illnesses include systemic hypertension (n=63, 42%), Diabetes mellitus (n=67, 44%), cardiac diseases with intake of antiplatelet/anticoagulant drugs (n=47, 31%) and liver disease (n=8, 5%). Left sided involvement (n=70, 47%) were more common.85 patients (56%) had homogenous type, 35 patients (24%) had separated type, laminar type in 20 patients (14%), trabecular type in 10 patients (6%). All patients underwent surgical evacuation of chronic SDH. Recurrence was observed in 20 patients (13%). Recurrences were more common in patients with cardiac diseases on antiplatelet/anticoagulant drugs (n=15) compared to patients with no cardiac disease (n=5) with statistically significant p value of.00001. Of the radiological types, separated type is associated with statistically significant recurrences with p value of.001231.139 patients (92%) showed clinical improvement following surgical evacuation of chronic SDH. Conclusion: Recurrence following surgery greatly increases the morbidity and mortality. Recurrence rate was found to be high in patients with cardiac diseases taking antiplatelet/anticoagulant drugs and in patients having separated type of chronic SDH.