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How Lagos hospital saved life of subdural empyema patient

All it took was one ball fall, and life began to change for Godisgreat, a 16-year-old boy that complained of headache and a fever, but was treated for typhoid. After being placed on admission and discharged from a hospital in Badagry, he still complained of these headaches and fever. He went back to the hospital and was asked to do an X-ray.

Godisgreat was then referred to Badagry General Hospital, where he was sent for a CT scan. He was again referred to a Navy hospital, but there was no equipment to handle the medical situation. He was eventually taken to Lagoon Hospitals by his family.

Godisgreat’s condition had got worse after his parents spent all of their money in various hospitals. For the family, Lagoon Hospitals was the last hope.

There are two interviews here. One is with Chinazor Onyia, the neurosurgeon at Lagoon Hospitals, Lagos, who successfully carried out a subdural empyema surgery on Godisgreat. The other is with Mowa Falase, a paediatrician and medical director at Lagoons Hospitals.

In the first interview, Onyia spoke with ANTHONIA OBOKOH on the need for Nigerians to know the complications, symptoms and signs of this rare infection.

What were the results of the CT scan?

Godisgreat was diagnosed of subdural empyema. The CT scan showed a hypodense collection in frontal region of the subdural space (space between the skull bone and brain) with a collection of gas above it. Based on clinical features and radiological findings, the diagnosis was a bi- frontal (involvement of both side of the anterior aspect of the subdural space) subdural empyema.

 So what sort of treatment plan did you put forth for this case?

The decision was that Godisgreat needed an operation immediately. It was an emergency as the situation was critical.

So we made a borehole in the skull or a smaller opening, because the pus had gone beyond the features. I had to open more because of his age so that I would be able to drain it properly and that was what I did.

During the surgery, findings were a collection of foul-smelling pus on both sides of the anterior of the subdural space, extending into the frontal sinus. The pus was evacuated; he was subsequently placed on antibiotics and he is currently doing well after he has been discharged.

How prevalent is subdural empyema in Nigeria?

It has been studied. The prevalence of subdural empyema worldwide is approximately five to ten per cent. The prevalence of subdural empyema is high in developing countries generally than in developed ones. However, parents need to be enlightened on this here in Nigeria.

How can subdural empyema be diagnosed and how complicated is it?

On Godisgreat’s case, history helps us to diagnose, investigate and find the likely reason why this happened. So, it is applicable to other clinical matters.

We suspected that he had recurrent catarrh after the fall, which became unusual with yellow mucus, which was a sign of infection.

Sometimes, patients’ immunity and capacity to fight infections could be from not having good diets, and some common factors can expose the patient to viral infections and when that is done, the risk of having bacteria occurs.

On complications, sometimes someone will have clinical problem, they might offer information that they feel could help in diagnosis, but knowing the clinical problem is very necessary because problems might have been there. Subdural empyema complication can rapidly spread to involve an entire cerebral hemisphere.

What are the symptoms and signs of subdural empyema?

Patients with subdural empyema develop meningeal signs. Most of the times, subdural empyema tends to occur in teenagers/ adolescents.

Subdural empyema often causes recurrent sinusitis or sinus infection, which is inflammation of the air cavities within the passages of the nose.

When young adolescents have sinusitis, they tend to have recurrent headache, fever and because the catarrh is infected, the pus occurs which puts pressure on the brain.

Another sign is if all symptoms are ignored, the patient might develop seizures that usually progress over several days, or even recurrent convulsion.

And if nothing is done at this stage, the patient will begin to have impaired abnormalities like speech loss or might even be in coma.

Can subdural empyema lead to death?

Most of the time, it can lead to death but not sudden death. However, problems with the brain follow a cause because they progress with symptoms. The collections of the problem with the brain tell us what the issue is and the thing to do to carry out necessary surgery with the brain.

The challenge is just to access the pocket of the pus because, sometimes, it might not be really easy. 

 Falase

In this interview, Falase says the entire staff put together their support and saved Godisgreat’s life.

 According to her, the surgery took place on the 22nd of May this year, with the assistance of a senior member of the facility who saw that he would not survive much longer with an operation and recommended that the surgery be done  pro- bono( free of charge).

“The family was supposed to deposit at least N3.5 million for the operation to take place, but they didn’t even have enough money to register him as a new patient.

Falase discloses that Nigeria only has 81 neurosurgeons in the country, noting that these specialists are rare and should well remunerated and cared for in Nigeria.

“Godisgreat’s case is just one in a million. My advice to all Nigerian parents is to help protect their children’s health and listen to their complaints because not all signs are fever.

“If you have cold beyond two weeks, there is a need for you to see your family physician, paediatrician, an ear, nose and throat specialist that can pick those symptoms, so they can be treated on time,” she counsels.

In appreciation to the organisation, Godwin and Veronica Ebhodaghe, parents of the patient, thanked the hospitals for saving their son’s life and commended the professionalism and warmth of staff.

 “The care I received has inspired me. I thank everyone working here,” says Godisgreat. “I would like to be a military medical doctor when I grow up,” he adds.

 

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