The role of corticosteroids in the management of chronic subdural hematomas: a critically appraised topic.
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.
Zarkou
Srijana
S
Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
Aguilar
Maria I
MI
Patel
Naresh P
NP
Wellik
Kay E
KE
Wingerchuk
Dean M
DM
Demaerschalk
Bart M
BM
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
D000305:Adrenal Cortex Hormones; D003907:Dexamethasone