Non-traumatic chronic subdural haematoma in an adolescent on maintenance haemodialysis: diagnostic and therapeutic challenges at the Ouahigouya Regional Teaching Hospital
DOI:
https://doi.org/10.64707/revstss.v49i1.1836Keywords:
chronic subdural haematoma, chronic haemodialysis, adolescent, hyperfiltrationAbstract
Abstract
Introduction : chronic subdural haematoma often follows minor head trauma, which occurs more frequently in elderly subjects. We report a case occurring in a 16-year-old undergoing chronic haemodialysis, whose symptoms were atypical.
Observation : this is a 16-year-old adolescent who has been on maintenance haemodialysis for 17 months for glomerular nephropathy, undergoing two weekly sessions of four hours each.
At the 10th month of haemodialysis, she developed signs of underdialysis, which led to an increase in the frequency of sessions to three per week with optimization of ultrafiltration. The patient developed severe headaches with effortless projectile vomiting, occurring at the onset of haemodialysis sessions and resolving after discontinuation, with no additional associated symptoms. This clinical presentation persisted for two weeks despite the administration of morphine, antiemetics, and hydrocortisone, given the hypotheses of an allergic reaction to the dialysate, cerebral oedema, or dialysis disequilibrium syndrome. A brain computed tomography scan revealed a left hemispheric chronic subdural hematoma with mass effect. The hematoma was evacuated through a burr hole. The postoperative course was uneventful, and the patient has remained free of intradialytic symptoms for the past five months.
Conclusion : hyperfiltration may have played a role in the development of the chronic subdural hematoma. Evacuation of the hematoma enabled the safe resumption of haemodialysis sessions. Therefore, brain computed tomography scanning is essential whenever neurological symptoms occur in maintenance haemodialysis patients.
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