Corticosteroid treatment for traumatic acute subdural haematoma, maybe not such a good idea

Description

An 86-year-old woman with acute blunt head trauma (the patient's head was hit by a car) 10 days ago, associated with a right occipital fracture and an acute subdural haematoma (treated in the department of neurosurgery by oral prednisone 80 mg once a day) (figure 1), presented with focal left arm motor seizures. At that time, CT and MRI showed right cortical venous thrombosis (figure 1), absent on initial CT imaging. Corticosteroids were stopped and antiepileptic drugs and anticoagulation (warfarin) started. Three weeks later, CT showed complete resolution of the cortical venous thrombosis and spontaneous resorption of the subdural haematoma. Blood analyses in search of a prothrombotic state were negative in the absence of other blood test abnormalities (including normal metabolic profile).

Figure 1

Initial CT showing frontal (A) and temporal (B) acute subdural haematoma and right occipital fracture (C and D),...

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