Resolution of Chronic Subdural Hematoma after Treatment with Tumor Necrosis Factor Alpha Inhibitor

Donald Ross

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DOI: 10.4236/nm.2011.24045                

Abstract

Background and Importance: Chronic subdural hematomas (cSDH) are a common problem for which solutions remain imperfect. Surgery is effective, but not without risk. Recent data have suggested a role for inflammation in the genesis of cSDH and several reports have documented some benefit to steroid treatment. In this report, a possible role for tumor necrosis factor alpha blockade in the resolution of a multiply recurrent cSDH is described. Clinical Presentation: An 86-year-old man with rheumatoid arthritis treated with infliximab presented with a large, symptomatic, multiloculated cSDH. Infliximab was withheld and craniotomy for evacuation was uncomplicated, but recurrent symptoms were noted and a recurrence was operated upon again several weeks later. Follow up CT showed a second recurrence. The patient requested to go back on his infliximab due to painful arthralgias. After a single dose of 10 mg/kg, follow up CT showed that the cSDH resolved and did not recur. Conclusion: Anti-TNF-alpha treatment with infliximab may have played a role in the resolution of this patient’s cSDH. Further investigation of this possible effect seems warranted.

Keywords

Chronic Subdural Hematoma, Tumor Necrosis Factor Alpha, Inflammation

Conflicts of Interest

The authors declare no conflicts of interest.

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