Nonsurgical treatment of chronic subdural hematoma with Chinese herbal medicine: A STROBE-compliant retrospective study

Abstract

The aim of the study was to observe the efficacy of nonsurgical treatment with Chinese herbal medicine (CHM) for chronic subdural hematoma (CSDH). This study includes clinical results of a STROBE-compliant retrospective study.Forty patients diagnosed with CSDH were recruited from outpatient. Different CHM prescriptions were dispensed for each patient based on syndrome differentiation until the patient had a stable neurologic condition for 2 weeks and/or CSDH completely resolved according to the computed tomography scan. Markwalder grading scale for neurologic symptoms and head computed tomography scan for hematoma volumes were performed before and after CHM treatment to evaluate efficacy.Patients received uninterrupted CHM treatment for 2.81 ± 1.45 months (0.75-6 months). The hematoma volume significantly reduced from 73.49 ± 35.43 mL to 14.72 ± 15.94 mL (P < .001). The Markwalder grading scale scores of patients at the end of CHM treatment decreased significantly, from 1.3 ± 0.69 to 0.15 ± 0.36 (P < .001). Ninety percent of the patients showed >50% decrease in the hematoma volume and complete improvement in neurologic symptoms. The linear regression analysis suggested that change in hematoma was significantly related to the duration of CHM treatment (R = 0.334; P < .001; Ŷ = 25.03 + 11.91X). Leonurus heterophyllus Sweet (Yi-Mu-Cao, 90.5%), Semen persicae (Tao-Ren, 88.8%), and Acorus tatarinowii Schott (Shi-Chang-Pu, 86.2%) were the top 3 single Chinese herbs prescribed in CHM treatment.The CHM treatment for CSDH based on syndrome differentiation with appropriate duration relieved neurologic symptoms quickly and promoted hematoma absorption effectively. It could be an effective nonsurgical therapy for CSDH.

Figure 1

The hematoma volumes of chronic subdural hematoma (CSDH) patients reduced significantly after Chinese herbal medicine treatment.

Figure 2

The Markwalder grading scale (MGS) scores of chronic subdural hematoma (CSDH) patients decreased significantly after Chinese herbal medicine treatment.

Figure 3

Case 3 (A–C, head computed tomography scan) was an 84-year-old male patient with a recurrent chronic subdural hematoma (CSDH) in left frontal parietal 2 weeks after burr-hole drainage operation. He had a definitive history of head trauma before first CSDH. He suffered from headache, dizziness, and weak limbs, and the score of Markwalder grading scale (MGS) was 2 when enrolled in this study. The hematoma volumes were measured as 99.03 mL (A), 18.86 mL (B), and almost undetectable (C) before, after Chinese herbal medicine (CHM) treatment lasting for 3 months, and in 6 months after CHM treatment termination. Case 39 (D–F, head computed tomography scan) was a 62-year-old female patient who suffered from headache 1 week, with a definitive history of head trauma and MGS 2. She had left frontotemporal subdural hematoma of 77.86 mL (D), with midline shift to right and cerebral hernia. After CHM treatment lasting for 2 months, the hematoma volume reduced to 5.55 mL (E) without midline shift and cerebral hernia, and at the end of CHM treatment, the hematoma was almost undetectable (F).

Figure 4

Linear regression analysis of length of Chinese herbal medicine (CHM) treatment and change of hematoma volume in chronic subdural hematoma patients.