Original ArticleNonsurgical Treatment of Chronic Subdural Hematoma with Steroids
Introduction
Surgery is the primary mode of treatment for symptomatic chronic subdural hematoma (SDH). Some of the earlier studies demonstrated the role of steroids in its medical management. Berghauser Pont et al1 in their systematic review stated that 5 observational studies noted the benefit of corticosteroids in the treatment of chronic SDH. Sun et al2 in their study concluded that steroid treatment is a good option in a selected group of patients.
The aim of our study is to evaluate the role of steroids in the medical treatment of chronic SDH and to evaluate the subgroup of patients who respond to them.
Section snippets
Methods
This is a prospective case study done in the Neurosurgery Department of NRI Medical College and General Hospital. The study period was from April 2013 to May 2015 (26 months). All patients admitted with diagnosis of chronic SDH with a Glasgow coma score (GCS) of 15/15 are included. Patients who were drowsy with a GCS of <15 and patients with an acute chronic SDH are excluded. Institute ethical committee approval wasobtained. Each patient and their attendants gave their consent before starting
Results
Twenty-six consecutive patients were treated in the neurosurgery unit as per the protocol. The gender distribution was 20 men and 6 women, corresponding to a male-to-female ratio of 3.3:1. The mean age was 60 years (range, 32–77 years) (Table 1).
The patients presented with weakness of limbs (13 patients), headache (14), altered behavior (9), giddiness and vomiting (3), speech disturbances (2), and hemisensory symptoms (1 patient). The signs include hemiparesis (17 patients), disorientation
Discussion
Many factors might be responsible for enlargement of chronic SDH after the initial small bleed. Microbleeds from the endothelial gap junctions, as explained by Markwalder3 and Yamashima et al,4 anticoagulant and profibrinolytic theory, as noted by Fujisawa et al,5 inflammatory and growth factors theory as proved by increased concentration of VEGF in chronic SDH by Suzuki et al,6 were accepted theories of pathophysiology of chronic SDH. Many other investigators also noted inflammatory and growth
Conclusions
Steroids appear to play a role in the nonsurgical medical treatment of chronic SDH. Patients with lower grades of chronic SDH can be treated successfully with steroids. Female patients seem to do better with steroids.
Acknowledgment
The first author acknowledges the discussions in the Vijayawada Neuro Club, Vijayawada, Andhra Pradesh, India, that are responsible for the initiation of the study.
References (19)
- et al.
Immunohistochemical localization of tissue-type plasminogen activator in the lining wall of chronic subdural hematoma
Surg Neurol
(1991) - et al.
Dexamethasone treatment in chronic subdural haematoma
Neurochirugia (Astur)
(2009) - et al.
Causes, epidemiology, and risk factors of chronic subdural hematoma
Neurosurg Clin N Am
(2000) - et al.
The role of corticosteroids in the management of chronic subdural hematoma: a systematic review
Eur J Neurol
(2012) - et al.
Non-surgical primary treatment of chronic subdural haematoma: preliminary results of using dexamethasone
Br J Neurosurg
(2005) Chronic subdural hematomas: a review
J Neurosurg
(1981)- et al.
The role of endothelial gap junctions in the enlargement of chronic subdural hematomas
J Neurosurg
(1983) - et al.
Increased concentration of vascular endothelial growth factor (VEGF) in chronic subdural hematoma
J Trauma
(1999) - et al.
Physiopathogenesis of subdural hematomas: part II: inhibition of growth of experimental hematomas with dexamethasone
J Neurosurg
(1976)
Cited by (0)
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.