The Long-Term Prospective Follow up Protocol for the Treatment of Chronic Subdural Hematoma: A Dexapril Study

Today, chronic subdural hematoma (CSDH) is one of the most usual/common neurosurgical conditions and the conservative management like Dexapril (Dexamethasone and Captopril) protocol is achievable in patients with CSDH. In this prospective cohort study, we proposed and evaluated the effectiveness of Dexapril protocol for the management of CSDH.

The study population included all patients (N= 117) who referred to Emtiaz Hospital in Fars Province from January 2014 to December 2016. A CT scan was performed at the time of referral; after that, Dexamethasone and Captopril were administered. Then, control CT scan was performed at 24 hour, 48 hour, and 96 hour intervals from the moment of admission.  One case was excluded due to a decrease in blood pressure after the first administration of Captopril.  Follow up visits have been conducted continuously at intervals of 1 month, 3months, 6 months, and 12 months since the date of the first admission.

13 (11.2%) CSDH cases had chronic subdural hematoma who presented with multiple loculations “suggesting repeated hemorrhages in the subdural space.” 11 (9.4%) of all cases underwent a burr-hole craniostomy due to the patient's unwillingness to continue his/her treatment, an increase in unilateral or bilateral weakness of the limb, and significantly increased BS (more than 250) after taking Dexamethasone. In 71 (61.2%) cases, there was not any changes in the first and last weakness score and there was no compelling reason for this lack of difference. Furthermore, none of the CT scans had a midline shift of more than 5mm after 3 months of follow ups. Also, no mortality due to relapse or an increase in the volume of chronic subdural was witnessed in the follow up sessions.

We have currently revealed that Dexapril protocol is effective in non-surgical treatment of  CSDH with minimum side effects. Adjuvant Dexapril therapy may contribute to the surgical therapy in reaching a lower recurrence rate.