Statins: An Alternative To Surgical Treatment Of Chronic Subdural Haematoma In The Poly Pathological Elderly?

Abstract

Chronic subdural haematoma is a frequent pathology of the elderlý especially in comorbid terrain. The treatment is almost always  surgical. Sometimes this surgery is not possible and a medical treatment based on corticosteroids is most often required. We report the  cases of two patients followed for chronic subdural haematoma with several comorbidities and ineligible for surgery. A statin-based  treatment was initiated. The aim is to consolidate the hypothesis of medical management of chronic subdural haematoma. The first case  was about an 87-year-old patient followed in cardiology for cardiac arrhythmia with a Pacemaker insertion in 2021 on Aspirin 100mg and  oral anti-diabetic and insulin therapy for 15 years. Clinically, he presented with intense headaches without neurological deficit. The brain  scan performed revealed a chronic left hemispheric subdural hematoma with mass effect. Treatment with atorvastatin at a dose of 20mg/ day for three months was initiated. The evolution was marked by the disappearance of headaches after two weeks. After three months of  treatment, the haematoma disappeared completely. The second patient was an 83-year-old man also followed in cardiology for heart  failure and in gastroenterology for a gastric tumour undergoing chemotherapy who had been suffering for three weeks from intense  headaches with left hemiparesis. Brain CT scan: right hemispheric subdural hematoma with mass effect. Treatment with atorvastatin  20mg was started for three months with radiological controls at one month and three months with a favourable evolution.