Nonsurgical Treatment of Chronic Subdural Hematoma with Steroids

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.

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.

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.

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.