Medical management of chronic subdural hematoma with low-dose dexamethasone: A case series study

Abstract

Introduction: Dexamethasone, by its anti-inflammatory action, can help to treat chronic subdural hematoma (CSDH). The ideal dosage and duration of treatment with dexamethasone is still unclear. The purpose of this study was to investigate the use of low-dose dexamethasone as the primary management of CSDH. Methods: This study retrospectively reviewed the data of CSDH patients managed in our University Hospital between January 1st, 2018, and December 31st, 2021. The patients received a daily oral dose of 1.5 mg of dexamethasone until complete radiological cure. The clinical follow-up assessment was every two weeks for one month, and monthly thereafter. Follow-up brain CT was performed monthly. Results: Fifty-three consecutive patients met the selection criteria for this study. The mean age of the patients included was 74.2 years (ranging from 67 to 79 years). The steroid therapy was well tolerated by all patients. No serious adverse effects occurred in any patient. All the hematomas completely disappeared within a mean period of 2.3 months (ranging from two to three months). No surgical intervention was needed for any patient. Conclusions: The results of this study suggest that low-dose dexamethasone appears safe and could be a valid option in the management of CSDH in normally alert and oriented patients. A prospective, placebo-controlled study is needed to confirm the effect of low-dose dexamethasone on CSDH and to assess the incidence of spontaneous resolution of the hematoma.