Subdural Hyperintense Band on Diffusion-Weighted Imaging of Chronic Subdural Hematoma Indicates Bleeding From the Outer Membrane

Background: The incidence of chronic subdural hematoma (CSDH) has been found to increasing in younger patients. This study was aimed to evaluate the role of outer membrane histopathology and comparison with the clinic-radiological aspects of chronic subdural hematoma in different age groups.Methods: Cases of CSDH admitted to the Neurosurgery department during January 2014 and December 2016 were included in the study. They were analyzed clinically, radiologically like site, size, thickness in computed tomography, the attenuation value and midline shift. Histopathological features were also recorded. Cases of acute and chronic sub dural hematoma which were managed conservatively irrespective of age and sex were excluded from the study.Results: Total 196 patients were included with median age of 66 yrs. The most common histopathological type of membrane was the scar inflammatory membrane (Type IV) in 43% of cases followed by hemorrhagic inflammatory membrane (Type III) in 31% of cases while the scar inflammatory type of membrane (Type II) was in 26% of cases. Young age group patient having less thickness of hematoma (<2cm) and having hyper density on CT scan. Old age group had more thickness(3.2cm) and mixed density with multiple layering.Conclusions: Young age group patient having less thickness of hematoma and hyper density compared to old age group. Recurrence and bilateral disease were more common in old age group associated with brain atrophy. Histopathological study completes the spectrum of CSDH in terms of severity of disease and overall prognosis of patient.

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The Protective Role of Heme Oxygenase-1 (HO-1) in Chronic Subdural Hematoma

Neurosurgery ◽

10.1093/neuros/nyz310_686 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Hui-Tzung Luh

Keyword(s):

Outer Membrane ◽

Heme Oxygenase ◽

Negative Correlation ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Significant Negative Correlation ◽

Enzyme Linked Immunosorbent Assay ◽

Heme Oxygenase 1 ◽

Consecutive Series ◽

Inflammatory Status

Abstract INTRODUCTION Many studies have revealed that angiogenesis and inflammation are closely linked to the pathophysiology of chronic subdural hematoma (CSDH). The development of CSDH is an inflammatory process that begins as a local inflammatory reaction of the dura meter to injury or external stimuli such as blood or CSF. This process causes neovascularization of the outer membrane of CSDH and vascular hyperpermeability. Heme oxygenase-1 (HO-1) is a key enzyme that catalyzes the degradation of heme and produces biliverdin, ferrous iron, and carbon monoxide. HO-1 expression is induced by oxidative stress, and the increasing expression seems to be protective in animal studies. We hypothesized that HO-1 has a protective impact on the severity of CSDH. METHODS This study is designed to correlate the histopathology of the outer membrane of CSDH and HO-1 level in the CSDH hematoma as an indicator of inflammatory status with the clinical presentation of patient and computed tomography (CT) radiological findings of a consecutive series of patients suffered from CSDH. This is a single-center, perspective cohort study. From 2014 to 2017, we enrolled 97 patients with CSDH, who has undergone surgical intervention (burr-hole drainage or craniotomy evacuation). We collect the clinical data, radiological information, and outer membrane and supernatant of the CSDH. We use enzyme-linked immunosorbent assay (ELISA) to measure the concentration of HO-1 in the supernatant of CSDH. RESULTS A significant negative correlation between the HO-1 and the thickness of CSDH is noted (P = .001). On increasing HO-1 by 1 ng/L, the CSDH thickness decreases by 81 mm (P < .005). CONCLUSION Our study demonstrates that HO-1, an important enzyme in angiogenesis and in the inflammation pathway, has a key impact on CSDH severity. A significant negative correlation between the HO-1 and thickness of CSDH has been proved.

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Clinical Features According to the Histological Types of the Outer Membrane of Chronic Subdural Hematoma

Korean Journal of Neurotrauma ◽

10.13004/kjnt.2015.11.2.70 ◽

2015 ◽

Vol 11 (2) ◽

pp. 70 ◽

Cited By ~ 3

Author(s):

Min Ho Park ◽

Chang Hyun Kim ◽

Tack Geun Cho ◽

Jin Kyu Park ◽

Jae Gon Moon ◽

...

Keyword(s):

Outer Membrane ◽

Clinical Features ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Histological Types

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Microvascular proliferation in the clots: The key finding of acute subdural hematoma transforming into chronic subdural hematoma?

Surgical Neurology International ◽

10.25259/sni_1103_2021 ◽

2021 ◽

Vol 12 ◽

pp. 601

Author(s):

Aito Watanabe ◽

Satoshi Tsutsumi ◽

Senshu Nonaka ◽

Hisato Ishii

Keyword(s):

Outer Membrane ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Nodular Lesion ◽

Neurological Deficits ◽

Cranial Computed Tomography ◽

Acute Subdural Hematoma ◽

Partial Removal ◽

Cerebral Magnetic Resonance Imaging ◽

Microvascular Proliferation

Background: Despite extensive investigations, the exact etiology of chronic subdural hematoma (CSDH) remains elusive. Organized CSDHs are a distinct but less-understood type of CSDH. Case Description: A 50-year-old hypertensive woman experienced headache without any previous head injury. At presentation, the patient showed no focal neurological deficits. Cranial computed tomography (CT) revealed a slightly compressive subdural hematoma that spontaneously regressed and no intracranial vascular lesions. Cerebral magnetic resonance imaging identified a non-enhancing nodular lesion in the subdural hematoma. After the patient presented disorientation and aphasia on post hospitalization day 14, CT showed a considerable enlargement of the subdural hematoma. Partial removal of the bi-layered hematoma was performed through a parietal craniotomy. Histological examination revealed microvascular proliferation in both the outer membrane and the nodular lesion. On postoperative day 35, CT demonstrated a remarkable resolution of the residual hematoma. Conclusion: Development of microvascular proliferation in the clots of an acute subdural hematoma may lead to its rapid enlargement as an organized CSDH. Organized CSDH can be managed by partial removal of the outer membrane and hematoma through a craniotomy.

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