Statins: an alternative to surgical treatment of chronic subdural haematoma in the poly pathological elderly?

Abstract

Chronic subdural hematoma is a prevalent condition among the elderly, particularly when accompanied by concurrent medical conditions. Surgical intervention is typically the primary treatment. However, in cases where surgery is not feasible, corticosteroid-based medications are often utilized instead. We present two cases of patients with chronic subdural hematoma and multiple comorbidities who were not candidates for surgery. In these instances, therapy with statins was initiated. The first case involved an 87-year-old man who had been managed by a cardiologist for heart arrhythmia and had a pacemaker implanted in 2021. He was on Aspegic 100 mg and had been receiving oral diabetes and insulin therapy for 15 years. Clinically, he presented with severe headaches without neurological deficits. Brain MRI revealed a chronic left hemisphere subdural hematoma with mass effect. Treatment with atorvastatin at a dosage of 20mg/day for three months was initiated. After two weeks, the headaches ceased, and after three months of medication, the hematoma had completely resolved. The second patient, an 83-year-old male, was being treated by cardiology for heart failure and gastroenterology for a gastric tumor undergoing chemotherapy. He experienced acute headaches for three weeks along with hemiparesis. A head CT scan revealed a right-sided subdural hematoma with mass effect. A favorable response was observed during the three-month treatment course with 20 mg of atorvastatin, with radiological assessments at one and three months.