Chronic subdural hematoma: tailoring treatment

Miah, I.P. (2022)

Doctoral Thesis

A chronic subdural hematoma (CSDH) is an intracranial bleeding between the outer two meninges of the brain due to rupture of cerebral veins or an inflammatory response in the subdural space. Elderly patients using anti-thrombotic therapy are at higher risk for hematoma development. A rise in CSDH incidence is expected because of the aging population and increase in anti-thrombotic therapy use due to cardiovascular disease. To date, no treatment guideline exists regarding optimal CSDH treatment. Surgery with subdural drainage is the mainstay treatment. However, due to relevant surgical complications, a recurrence risk up to 30% and increased mortality in this vulnerable patient population, corticosteroid therapy is being administered as an alternative or adjuvant treatment modality.
In this thesis we have shown that surgical treatment results in significantly better treatment outcome than medicinal approach by the corticosteroid dexamethasone in a retrospective study (chapter 2) as well as in a randomized controlled trial (chapter 3 and 4). Furthermore, we revealed radiological markers that are of prognostic value to predict treatment outcome after surgery (chapter 5) and dexamethasone therapy (chapter 6) in symptomatic CSDH patients.

• CSDH
• Traumatic brain injury
• TBI
• Dexamethasone
• DXM
• Corticosteroid
• Computed tomography

• All authors: Miah, I.P.
• Supervisor: Peul, W.C.
• Co-supervisor: Jellema, K.; Gaag, N.A. van der
• Committee: Wermer, M.J.H.; Bartels, R.H.M.A.; Vandertop, W.P.; Tisell, M.
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2022-09-29
• ISBN (print): 9789464218176
• Sponsorship: Funding was non-commercial by the Jacobus Foundation The Hague