Chioma Umeha
For God Is Great, a 16-year-old boy, the success
of his surgery from subdural empyema is a clear manifestation of the divine
fulfilment of his name.
Subdural empyema is an intracranial focal
collection of purulent material located between the dura mater and the
arachnoid mater.
God Is Great was diagnosed with subdural empyema
early this year. The CT scan showed a hypodense collection in the 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.
It all began with a simple complaint of a headache
and fever but was treated for typhoid. After being placed on admission and
discharged from a hospital in Badagry, he still complained of the headaches and
fever. He went back to the hospital and was asked to do an x-ray.
God Is Great 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.
God Is Great’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.
Dr Mowa Falase, a Paediatrician and Medical
Director at Lagoon Hospitals, Lagos, while confirming this told DAILY
INDEPENDENT, “Circumstances under which he came to us will make anybody say God
Is Great; he is certainly living up to his name.
“He came in that evening to us and this time I am
referring to is when every government hospital decided to go on strike.
Usually, the two teaching hospitals in Lagos are not usually on strike at the
same time, but this time both of them decided to go on strike.
“Both the Lagos University Teaching Hospital
(LUTH), Lagos State University Teaching Hospital (LASUTH), even all General
Hospitals, decided to go on strike and then God Is Great came here. It is
common thinking that once teaching hospitals are on strike there are not many
other places that can handle his sort of case.
“But, he came in, and we saw him and he had a CT
scan that determined the problem that he had which involved his brain and the
treatment required.
“So it was decided that he needed surgery on his
brain, I mean around his brain, understandingly, this kind of surgery usually
cost a lot of money. However, he had been carrying the condition for so long
that waiting in his case would have caused more damage than anything else.”
Dr Falase also disclosed that the entire staff put
together their support and saved God Is Great’s life. According to her, the
surgery took place on May 22, 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 is 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.
She revealed that Nigeria only has 81
neurosurgeons in the country, noting that these specialists are rare and should
well be remunerated and cared for in Nigeria.
“God Is Great’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 a fever.
“If you have a 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 counselled.
In appreciation of 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 the staff.
“The care I received has inspired me. I thank
everyone for working here,” God Is Great told DAILY INDEPENDENT. “I would like
to be a military medical doctor when I grow up,” he added.
On his part, Dr Chinazor Onyia, the neurosurgeon
at Lagoon Hospitals who performed the surgery explained, “The decision was that
God Is Great needed an operation immediately. It was an emergency as the
situation was critical.
“So we drilled a hole 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,” the doctor clarified.
During the surgery, findings were that a
collection of foul-smelling pus on both sides of the anterior of the subdural
space, extending into the frontal sinus, he added.
The pus was evacuated; he was subsequently placed
on antibiotics and he is currently doing well after he has been discharged, the
neurosurgeon added.
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 about this
here in Nigeria, Dr Onyia advised and added, “On God Is Great’s case, history
helps us to diagnose, investigate and find the likely reason 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, the neurosurgeon also explained.
On complications, he said, sometimes someone will
have a clinical problem, he might offer information that they feel could help
in diagnosis, but knowing the clinical problem is very necessary because
problems might have been there.
Giving further details, Dr Onyia said, “Subdural
empyema complication can rapidly spread to involve an entire cerebral
hemisphere.
“Patients with subdural empyema develop meningeal
signs. Most of the times, subdural empyema tends to occur in teenagers/
adolescents. It 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 a recurrent headache, fever and because the catarrh is infected, the
pores occurs which puts pressure on the brain.”
He also explained, “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 would begin to have impaired abnormalities like speech loss
or might even be in a coma.
“Most of the time, subdural empyema 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 the necessary
surgery with the brain,” he said.
