title: The role of corticosteroids in the management of chronic subdural hematomas: a critically appraised topic.
abstract: BACKGROUND
  Chronic subdural hematomas (CSDH) occur most commonly in the elderly population. When CSDH patients present with a moderate or severe neurologic deficit and are good surgical candidates, surgery is regarded as the ideal option. However, CSDH patients often have only mild neurologic deficits or are not optimal candidates for surgery. Corticosteroids are often used on these subgroups, but the benefit of this intervention is unknown. Optimal treatment for these patients is not well established.
  
  
  OBJECTIVE
  Critically evaluate the role of corticosteroids in the management of CSDH.
  
  
  METHODS
  The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a structured question, search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and clinical content experts in the fields of vascular neurology and neurosurgery.
  
  
  RESULTS
  No randomized controlled trials on the topic were discovered. A prospective cohort study was selected as the best currently available evidence.
  
  
  CONCLUSIONS
  The role of corticosteroids in the management of CSDH is not well defined. Current evidence neither supports nor refutes the use of corticosteroids. A randomized controlled trial is warranted.
authors.affiliation: Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
authors.forename: Srijana
authors.initials: S
authors.lastname: Zarkou
authors.forename: Maria I
authors.initials: MI
authors.lastname: Aguilar
authors.forename: Naresh P
authors.initials: NP
authors.lastname: Patel
authors.forename: Kay E
authors.initials: KE
authors.lastname: Wellik
authors.forename: Dean M
authors.initials: DM
authors.lastname: Wingerchuk
authors.forename: Bart M
authors.initials: BM
authors.lastname: Demaerschalk
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D003907:Dexamethasone