Elsevier

World Neurosurgery

Volume 84, Issue 6, December 2015, Pages 1968-1972
World Neurosurgery

Original Article
Nonsurgical Treatment of Chronic Subdural Hematoma with Steroids

https://doi.org/10.1016/j.wneu.2015.08.044Get rights and content

Objective

Some studies demonstrated the role of steroids in medical management of chronic subdural hematoma (CSDH). Aim of our study is to evaluate the role of steroids in medical treatment of CSDH and to evaluate the subgroup of patients who respond to steroids.

Methods

This prospective case study was done for 26 months from April 2013 to May 2015. On admission, the parenteral steroid dexamethasone (4 mg) was given every 8 hours for 72 hours. If the patient improved, the oral tapering doses of steroids were continued for 1 month. Neurological assessment and computed tomography scan done after 6 weeks. If the patient had not improved at 72 hours, a standard burr hole and evacuation was done.

Results

Twenty-six consecutive patients were studied (20 men; mean age, 60.25 years). The average thickness of the hematoma was 21.9 mm, the mean midline shift was 10.3 mm, and the average attenuation value of bleed on computed tomography scan was 35.7. Eleven patients were treated successfully with steroid treatment, whereas 15 patients required surgery. The female gender, less midline shift, less density (Hounsfield units) were noted to be associated with successful medical treatment. We propose a grading based on the total score given to the midline shift and density. Complications noted were hyperglycemia (1 patient), gastritis (1), and recurrence (1 patient). There was no mortality.

Conclusions

Steroids appear to play a role in the nonsurgical medical treatment of CSDH. Patients with lower grades of CSDH can be treated successfully with steroids. Female patients seem to do better 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.

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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.

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