Role of Dexamethasone in Recurrent and Residual Chronic Subdural Hematoma

Objectives:  To assess the effectiveness of dexamethasone in recurrent and residual chronic subdural hematoma as a monotherapy. Material and Methods:  A prospective Quasi-Experimental study was conducted at the Neurosurgery Department, Peoples Medical College Hospital, Nawabshah from July 2014 to June 2020.Patients were assessed by Markwalder’s neurological grading and intravenous dexamethasone was used as monotherapy and effects were monitored. Results:  Out of 280 patients100 patients had recurrent and 180 patients had a residual chronic subdural hematoma. Male n = 180, female n = 100 with male to female ratio 1.8:1. Patients with Markwalder Grade 0, 1, and 2 were included and Grade 3 & 4 with marked midline shift on plain Computed tomographic scan brain were excluded. Intravenous dexamethasone of 12 mg in three divided doses for 24 hours given for first 2 weeks then shifted on oral dexamethasone and gradually tapered in next 2 weeks. During this period patient was evaluated for fluctuation in blood sugar or epigastric pain. Serial follow-up of patient was done, 16.07% improved from Markwalder Grade – 2 to 0, Markwalder Grade 1 to 0 in 12.14%. Complete resolution of hematoma occurred in 53.57%. Radiological deterioration with increased volume of hematoma in n = 40 and worsening to Markwalder Grad – 3 n = 15 and Grade – 4 n = 25. Death in n = 11.  Conclusion:  Monotherapy with dexamethasone in recurrent and residual chronic Subdural Hematoma results in clinical improvement and reduces the rate of re-operation.