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.
Conclusion: 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.