title: A Pilot Placebo Controlled Randomized Trial of Dexamethasone for Chronic Subdural Hematoma.
abstract: BACKGROUND
  Current opinions regarding the use of dexamethasone in the treatment of chronic subdural hematomas (CSDH) are only based on observational studies. Moreover, the use of corticosteroids in asymptomatic or minimally symptomatic patient with this condition remains controversial. Here, we present data from a prospective randomized pilot study of CSDH patients treated with dexamethasone or placebo.
  
  
  METHODS
  Twenty patients with imaging-confirmed CSDH were recruited from a single center and randomized to receive dexamethasone (12 mg/day for 3 weeks followed by tapering) or placebo as a conservative treatment. Patients were followed for 6 months and the rate of success of conservative treatment with dexamethasone versus placebo was measured. Parameters such as hematoma thickness and clinical changes were also compared before and after treatment with chi-square tests. Adverse events and complications were documented.
  
  
  RESULTS
  During the 6-month follow-up, one of ten patients treated with corticosteroids had to undergo surgical drainage and three of ten patients were treated surgically after placebo treatment. At the end of the study, all remaining patients had complete radiological resolution. No significant differences were observed in terms of hematoma thickness profile and impression of change; however, patients experienced more severe side effects when treated with steroids as compared with placebo. Dexamethasone contributed to many serious adverse events.
  
  
  CONCLUSIONS
  Given the small sample size, these preliminary results have not shown a clear beneficial effect of dexamethasone against placebo in our patients. However, the number of secondary effects reported was much greater for corticosteroids, and dexamethasone treatment was responsible for significant complications.
authors: Centre de recherche du CHU de Québec,Axe neurosciences,Université Laval,Quebec City,Canada.
authors: Michel
authors: M
authors: Prud'homme
authors: Centre de recherche du CHU de Québec,Axe neurosciences,Université Laval,Quebec City,Canada.
authors: François
authors: F
authors: Mathieu
authors: Centre de recherche du CHU de Québec,Axe neurosciences,Université Laval,Quebec City,Canada.
authors: Nicolas
authors: N
authors: Marcotte
authors: Centre de recherche du CHU de Québec,Axe neurosciences,Université Laval,Quebec City,Canada.
authors: Sylvine
authors: S
authors: Cottin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone
keywords: Asymptomatic or mildly symptomatic; chronic subdural hematoma; corticosteroids; randomized controlled pilot study