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

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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Chronic subdural hematoma in infancy

Journal of Neurosurgery ◽

10.3171/jns.1990.73.2.0201 ◽

1990 ◽

Vol 73 (2) ◽

pp. 201-205 ◽

Cited By ~ 42

Author(s):

Nobuhiko Aoki

Keyword(s):

Computerized Tomography ◽

Subdural Hematoma ◽

Treatment Protocol ◽

Chronic Subdural Hematoma ◽

Neurological Deficits ◽

Acute Subdural Hematoma ◽

Hemorrhagic Diathesis ◽

Content Type ◽

Fine Print ◽

Subdural Tapping

✓ The cases of 30 infants with chronic subdural hematoma treated surgically between 1978 and 1987 (after the introduction of computerized tomography) were reviewed. This series was limited to infants presenting with increased intracranial pressure, neurological deficits, or developmental retardation. Nineteen patients were male and 11 were female, ranging in age from 1 to 14 months (average 6.1 months). The surgical treatment was initiated with percutaneous subdural tapping which was repeated periodically, if indicated, for 2 weeks. If the patients failed to respond to subdural tapping, subdural-peritoneal shunting was installed. The follow-up periods were from 3 months to 9 years 8 months (average 4 years 10 months). Computerized tomography at that time disclosed disappearance or minimal collection of subdural fluid in 28 cases (93%) and a significant collection (> 5 mm) in two (7%). Neurological examination revealed that the patients were “normal” in 17 cases (57%), “mildly or moderately disabled” in nine (30%), and “severely disabled” in four (13%). The majority of disabled patients had lesions secondary to infantile acute subdural hematoma, child abuse, or hemorrhagic diathesis. These results indicate that the treatment protocol in the present series is acceptable for the elimination of subdural hematoma. Together, early diagnosis and treatment of the etiological conditions causing the lesion are indispensable for obtaining a satisfactory neurological outcome.

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Enlarged Craniotomy with Membranectomy for Treatment of Completely Organized Chronic Subdural Hematoma: A Case Report and Literature Review

10.21203/rs.3.rs-35500/v1 ◽

2020 ◽

Author(s):

Xiao-Yong Shi ◽

Jin-Xia Zhang ◽

Zhu-Xiao Tang ◽

Hu Sun ◽

Zheng Shen

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

The Elderly ◽

Cranial Computed Tomography ◽

Acute Subdural Hematoma ◽

Cerebral Contusion ◽

Liquid Component ◽

Case Presentation ◽

Car Accident ◽

The Brain

Abstract Background Chronic subdural hematoma(CSDH) is a common condition in the elderly which can be treated by burr hole trephination and drainage. But completely organized chronic subdural hematoma(OCSH) is rare which cannot be cured by this technique, only treated by enlarged craniotomy and membranectomy.Case Presentation A 74-year old man admitted to hospital for loss of consciousness for one hour following a car accident. Cranial computed tomography (CT) showed a large mixed density hematoma on the left, acute subdural hematoma, cerebral contusion and subarachnoid hemorrhage. A left standard large craniotomy was performed. A large and completely OCSH with no liquid component was found during surgery, at the same time, we found no obvious adhesions between the inner membrane and the brain tissue, which was easy to separate and finally removed completely. Conclusion Craniotomy with membranectomy is a feasible method for treating completely OCSH.

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Bilateral Acute Subdural Hematoma Following Evacuation of Chronic Subdural Hematoma

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2007.41.4.267 ◽

2007 ◽

Vol 41 (4) ◽

pp. 267 ◽

Cited By ~ 4

Author(s):

Seok Won Kim ◽

Seung Myung Lee ◽

Ho Shin

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Acute Subdural Hematoma

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Spontaneous Acute Subdural Hematoma following Contralateral Calcified Chronic Subdural Hematoma Surgery: An Unusual Case

Pediatric Neurosurgery ◽

10.1159/000090468 ◽

2006 ◽

Vol 42 (2) ◽

pp. 122-124 ◽

Cited By ~ 5

Author(s):

M. Tatli ◽

A. Guzel ◽

N. Altinors

Keyword(s):

Subdural Hematoma ◽

Unusual Case ◽

Chronic Subdural Hematoma ◽

Acute Subdural Hematoma ◽

Calcified Chronic Subdural Hematoma

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Gradation density hematoma is a predictor of chronic subdural hematoma recurrence associated with inflammation of the outer membrane

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2020.105839 ◽

2020 ◽

Vol 194 ◽

pp. 105839

Author(s):

Yu Shimizu ◽

Cheho Park ◽

Kazuhiko Tokuda

Keyword(s):

Outer Membrane ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma

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Frequency of and Risk Factors for Chronification in Traumatic Acute Subdural Hematoma following Conservative Therapy

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1685188 ◽

2019 ◽

Vol 80 (05) ◽

pp. 359-364 ◽

Cited By ~ 2

Author(s):

Stefanie Kaestner ◽

Marina van den Boom ◽

Wolfgang Deinsberger

Keyword(s):

Risk Factors ◽

Subdural Hematoma ◽

Head Injuries ◽

Chronic Subdural Hematoma ◽

Length Of Hospital Stay ◽

The Elderly ◽

Coagulation System ◽

Acute Subdural Hematoma ◽

Neurosurgical Department ◽

Anticoagulant Medication

Background In an aging society, traumatic head injuries, such as acute subdural hematomas (aSDHs), are increasingly common because the elderly are prone to falls and are often undergoing anticoagulation treatment. Especially in advanced age, cranial surgery such as craniotomies may put patients in further jeopardy. But if treatment is conservative, a chronic subdural hematoma (cSDH) may develop, requiring surgical evacuation. Existing studies have reported a correlation between several risk factors contributing to the frequency of chronification. To improve the prediction of the course of disease and to aid counseling patients and relatives, this study aimed to determine the frequency and the main risk factors influencing the process of chronification of an aSDH following conservative treatment. Methods We identified patients presenting between January 2012 and September 2017 at our neurosurgical department with an aSDH. All patients treated conservatively were selected retrospectively, and the following parameters were documented: age, sex, chronification status, Glasgow Coma Scale score on admission and discharge, hematoma thickness and density, the degree of midline shift (MLS), prior anticoagulants and administration of procoagulants, thrombosis management, other coagulopathies, initial length of hospital stay, interval between discharge and readmission, and interval between initial injury and date of surgery and last follow-up. The cohort was divided into patients with complete resolution of their aSDH, and patients who needed surgery due to chronification. Results A total of 75 conservatively treated patients with aSDH were included. A chronification was observed in 24 cases (32%). The process of chronification takes an average of 18 days (range: 10–98 days). The following factors were significantly associated with the process of chronification: age (p = 0.001), anticoagulant medication (acetylsalicylic acid [ASA], Coumadin, and novel anticoagulants [NOACs]) before injury (p = 0.026), administration of procoagulants (p = 0.001), presence of other coagulopathies such as thrombocytopenia (p = 0.002), low hematoma density at discharge (p = 0.001), hematoma thickness on admission and discharge (p = 0.001), and the degree of MLS (p = 0.044). Conclusion Chronification occurred in a third of all patients with conservatively treated aSDH, on average within 3 weeks. The probability of developing a cSDH is 0.96 times higher with every yearly increase in age, resulting in 56% chronification in patients ≥ 70 years. Hematoma thickness and impairment of the coagulation system such as anticoagulant medication (ASA, Coumadin, and NOACs) or thrombocytopenia are further risk factors for chronification.

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