Tratamento Conservador de Hematoma Subdural Crônico Bilateral com Atorvastatina: um relato de caso

Conservative Treatment of Bilateral Chronic Subdural Hematoma with Atorvastatin: a case report

Cynthia Cardozo Lima (1)
Davi de Aguiar Portela (1)
Lucas Mainardo Rodrigues Bezerra (1)
Pedro Oliveira Carvalho Neto (1)
Ana Maria Santos Cardoso (1)
Isadora Maria Rodrigues Bezerra (1)
Cláudia Lorena Ribeiro Lopes (1)
Gisele Bezerra da Silva (2)
José Alberto Pereira Pires (3)
Madson Roger Silva Lima Filho (4)

https://doi.org/10.22290/jbnc.2023.340214
J Bras Neurocirur 34 (2): 253-257, 2023

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Downloads: 313

Resumo

Introdução: O hematoma subdural crônico (HSDC) é uma coleção encapsulada, de fluido, sangue e seus produtos de degradação em camadas entre os revestimentos da aracnoide e da dura-máter na superfície do cérebro, frequentemente observada na prática neurológica e neurocirúrgica. Relato de caso: Paciente do sexo masculino, 90 anos, deu entrada no consultório com queixa de confusão mental e cefaleia crônica persistente refratária a analgesia. Sabidamente cardiopata e em uso de ASS 100mg/dia, apresentando escala de coma de Glasgow (ECG) 14. Trouxe tomografia computadorizada (TC) de crânio evidenciando hematoma subdural crônico bilateral, com diâmetro maior à esquerda. Optou-se por tratamento conservador com atorvastatina 20mg/dia. Após 30 dias em uso da medicação retornou ao consultório assintomático, com ECG 15 e nova TC de crânio evidenciando melhora significativa das coleções subdurais bilaterais. Conclusão: A administração de atorvastatina pode modular a neuroinflamação no HSDC de forma eficaz, através de um mecanismo que envolve a alteração da invasão de leucócitos periféricos, a polarização alternativa da micróglia/macrófagos e a diminuição da deposição de colágeno. Tendo, portanto, efeitos antiangiogênicos, antiinflamatórios e fibrogênicos.

Palavras-chave

Hematoma subdural crônico; Tratamento conservador; Atorvastatina

Abstract

Introduction: Chronic subdural hematoma (CSDH) is an encapsulated collection of fluid, blood and its degradation products layered between the arachnoid and dura mater linings on the surface of the brain often seen in neurological and neurosurgical practice. Case presentation: A 90-year-old male patient was admitted to the medical office complaining of mental confusion and persistent chronic headache that would be refractory to analgesia. He was known to have heart disease and was taking ASS 100mg/day, presenting a Glasgow coma scale (GCS) 14. He brought a brain computed tomography (CT) scan showing bilateral chronic subdural hematoma, with a larger diameter on the left. We opted for conservative treatment with atorvastatin 20mg/day. After 30 days using the medication, he returned to the office asymptomatic, with a GCS of 15 and a new brain CT showing a significant improvement in the bilateral subdural collections. Conclusion: Atorvastatin administration can effectively modulate neuroinflammation in CSDH through a mechanism involving alteration of peripheral leukocyte invasion, alternative microglia/macrophage polarization, and decreased collagen deposition. Therefore, it has antiangiogenic, anti-inflammatory and fibrogenic effects.

Keywords

Chronic subdural hematoma; Conservative treatment; Atorvastatin

References

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1 Medical student, Faculdade de Ciências Humanas, Exatas e da Saúde do Piauí (FAHESP), Instituto de Educação Superior do Vale Do Parnaíba (IESVAP), Parnaíba (PI), Brazil.

2 Master in Women Health, Academic coordinator, Dirceu Arcoverde State Hospital (HEDA), Parnaíba (PI), Brazil.

3 MD, MSc, Neurosurgeon - Pain, Spine and Brain. Professor,Federal University of Maranhão; University Hospital of Federal University of Maranhão, São Luís, Maranhão, Brazil.

4 MD, Professor, Faculdade Ciências Humanas, Exatas e da Saúde do Piauí, Instituto de Educação Superior do Vale do Parnaíba (IESVAP), Parnaíba (PI), Brazil.

Received Dec 12, 2022

Accepted Dec 28, 2022

JBNC Brazilian Journal of Neurosurgery

ISSN (print version): 0103-5118
e-ISSN (online version): 2446-6786

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