scholarly journals Cerebrospinal fluid leak as a driving factor in chronic subdural hematoma formation: A histological study

2021 ◽  
Vol 12 ◽  
pp. 578
Author(s):  
Antonio Colamaria ◽  
Matteo Sacco ◽  
Savino Iodice ◽  
Nicola Pio Fochi ◽  
Francesco Carbone
Keyword(s):  
Cerebrospinal Fluid ◽  
Inflammatory Reaction ◽  
Subdural Hematoma ◽  
Histological Study ◽  
Fluid Collection ◽  
Traumatic Injury ◽  
Chronic Subdural Hematoma ◽  
Cerebrospinal Fluid Leak ◽  
Demographic Shift ◽  
Csf Leakage

Background: Chronic subdural hematoma (CSDH) represents the most common neurosurgical disease. Given the demographic shift toward an aging population, the overall incidence of this condition is increasing. Nevertheless, clarity in the pathophysiological process is yet to be made. Several etiological mechanisms have been proposed to initiate and consequently promote fluid collection in the subdural space. Traumatic injury of the bridging veins has long been considered the primum movens of the pathology but increasing evidence shows that trauma is not the only factor involved. Along with recent advances we sought to understand the role of the cerebrospinal fluid (CSF) in the buildup of the intense inflammatory reaction that characterizes CSDH. Methods: In the present study, we examined histological features of reactive membranes secondary to extracranial CSF leakage with CSDH-related membranes. Similarity and differences between the specimens were examined by means of light microscopy. Results: Histological similarities were consistently found between CSDH membranes and reactive membranes secondary to CSF leakage in the extracranial space. Activated histiocytes were highlighted in all specimens along with an intense inflammatory reaction. Conclusion: CSDH is most likely the result of a complex interaction among different pathophysiological events resulting from both traumatic and inflammatory etiologies. In the present work, we highlight how CSF leakage could be an early factor that leads to a cascade of events that culminates in CSDH formation.

Cerebrospinal fluid leakage into the subdural space: possible influence on the pathogenesis and recurrence frequency of chronic subdural hematoma and subdural hygroma

2008 ◽  
Vol 108 (2) ◽  
pp. 275-280 ◽  
Author(s):  
Rudolf A. Kristof ◽  
Jochen M. Grimm ◽  
Birgit Stoffel-Wagner
Keyword(s):  
Cerebrospinal Fluid ◽  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Postoperative Recurrence ◽  
Cerebrospinal Fluid Leakage ◽  
Subdural Space ◽  
Subdural Hygroma ◽  
Fluid Leakage ◽  
Csf Leakage

Object The purpose of this study was to clarify whether cerebrospinal fluid (CSF) leakage into the subdural space is involved in the genesis of chronic subdural hematoma (CSDH) and subdural hygroma (SH) and to clarify whether this leakage of CSF into the subdural space influences the postoperative recurrence rate of CSDH and SH. Methods In this prospective observational study, 75 cases involving patients treated surgically for CSDH (67 patients) or SH (8 patients) were evaluated with respect to clinical and radiological findings at presentation, the content of β -trace protein (β TP) in the subdural fluid (βTPSF) and serum (βTPSER), and the CSDH/SH recurrence rate. The βTPSF was considered to indicate an admixture of CSF to the subdural fluid if βTPSF/βTPSER > 2. Results The median β TPSF level for the whole patient group was 4.29 mg/L (range 0.33–51 mg/L). Cerebrospinal fluid leakage, as indicated by βTPSF/βTPSER > 2, was found to be present in 93% of the patients with CSDH and in 100% of the patients with SH (p = 0.724). In patients who later had to undergo repeated surgery for recurrence of CSDH/SH, the βTPSF concentrations (median 6.69 mg/L, range 0.59–51 mg/L) were significantly higher (p = 0.04) than in patients not requiring reoperation (median 4.12 mg/L, range 0.33–26.8 mg/L). Conclusions As indicated by the presence of βTP in the subdural fluid, CSF leakage into the subdural space is present in the vast majority of patients with CSDH and SH. This leakage could be involved in the pathogenesis of CSDH and SH. Patients who experience recurrences of CSDH and SH have significantly higher concentrations of βTPSF at initial presentation than patients not requiring reoperation for recurrence. These findings are presented in the literature for the first time and have to be confirmed and expanded upon by further studies.

Abstract WP429: Therapeutic Strategy For Chronic Subdural Hematoma Associated With Cerebrospinal Fluid Hypovolemia

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Takafumi Shimogawa
Keyword(s):  
Cerebrospinal Fluid ◽  
Subdural Hematoma ◽  
Therapeutic Strategy ◽  
Clinical Symptoms ◽  
Traumatic Injury ◽  
Chronic Subdural Hematoma ◽  
Treatment Result ◽  
Hematoma Evacuation ◽  
The Third ◽  
Blood Patch

Chronic subdural hematoma (CSH) with the cerebrospinal fluid (CSF) hypovolemia is often reported, but the therapeutic strategy is not established. We examined the therapeutic strategy and the treatment result for CSH with the CSF hypovolemia that we experienced in our hospital. [Object and method] In 544 patients with CSF hypovolemia during January 2000 to July 2012, 7 cases (1.3%) had CSH bilaterally. About CSF hypovolemia, 5 cases was diagnosed as spontaneous, 1 case as post-traumatic injury, and 1 case as post-traffic injury. We devided them into 3 groups; the first group which performed epidural blood patch (EBP) therapy first, the second group which performed hematoma evacuation for CSH first, and the third group group which performed the hematoma evacuation for CSH and EBP simultaneously. [Result] In the first group included 5 cases, only 1 case of CSH resolved spontaneously, and another 4 cases needed additional hematoma evacuation by aggravation of clinical symptoms. In the second group included 1 case, CSH recurred, and additional EBP therapy and hematoma evacuation were needed. In the third group included 1 case, the improvement of prompt clinical symptoms was obtained and CSH did not recurr. [Conclusion] The treatment for CSH with CSF hypovolemia needs EBP therapy first, however most cases needs an additional hematoma evacuation. If it takes into consideration, it may be better to do the hematoma evacuation and the EBP simultaneouly. In addition, it is necessary to consider a CSF hypovolemia as a cause of a bilateral CSH which relapse after treatment.

scholarly journals Neurological Deterioration Following Bilateral Burr-Hole Drainage for Chronic Subdural Hematoma: A Case Report

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Tomita Y
Keyword(s):  
Subdural Hematoma ◽  
Fluid Collection ◽  
Spontaneous Intracranial Hypotension ◽  
Chronic Subdural Hematoma ◽  
Arterial Embolization ◽  
Severe Case ◽  
Neurological Deterioration ◽  
Free Air ◽  
Unknown Reason ◽  
Neurologically Intact

Background: Spontaneous intracranial hypotension (SIH) is a relatively rare but known pathology that results in brain herniation or sagging due to CSF hypovolemia. SIH can commonly be misdiagnosed when occurring with other pathologies including chronic subdural hematoma (CSDH). Neurological decline caused by SIH is rare, but is often rapid and much more severe. Case description: A 69-year-old man was delivered to the emergency department for loss of consciousness and mild left hemiparesis. Brain computed tomography (CT) revealed increased density over basal cisterns suggestive of subarachnoid hemorrhage (SAH), and CSDH. Cerebral angiography showed dural arteriovenous fistula, but there was no apparent cerebral aneurysm. We first performed trans-arterial embolization using n-butyl cyanoacrylate, followed by bilateral hematoma evacuation. A postoperative CT showed that CSDH was evacuated, but the subdural space was filled with free air. A subsequent CT examination revealed mild re-accumulation of CSDH without significant brain compression. On postoperative day 14 the patient became progressively lethargic, for which he was transferred to the intensive care unit. As gadolinium-enhanced magnetic resonance imaging and radionuclide cisternography suggested the leakage of cerebrospinal fluid, an epidural catheter was inserted in the head- down positioned patient and an epidural infusion of saline was given for 3 days. The patient stabilized and regained consciousness over 2 weeks. The patient became neurologically intact with imaging showing almost complete parenchymal expansion and resolution of subdural fluid collection. Conclusion: This is an instructive case because the patient deteriorated after the surgery for CSDH, but it is also a unique case because the deterioration occurred over 14 days. This report emphasizes the possibility that SIH should be taken into consideration when there is an unknown reason for early CSDH recurrence and neurological deterioration.

scholarly journals Iatrogenic cerebrospinal fluid leak after repeated nasal swab tests for COVID-19: illustrative case

2021 ◽  
Vol 2 (17) ◽  
Author(s):  
Johnson Ku ◽  
Chieh-Yi Chen ◽  
Jason Ku ◽  
Hsuan-Kan Chang ◽  
Jau-Ching Wu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Nasal Cavity ◽  
Nasal Swab ◽  
Cerebrospinal Fluid Leak ◽  
Cribriform Plate ◽  
Csf Leak ◽  
Illustrative Case ◽  
Endoscopic Endonasal ◽  
Csf Rhinorrhea ◽  
Csf Leakage

BACKGROUND Nasal swab tests are one of the most essential tools for screening coronavirus disease 2019 (COVID-19). The authors report a rare case of iatrogenic cerebrospinal fluid (CSF) leak from the anterior skull base after repeated nasal swab tests for COVID-19, which was treated with endoscopic endonasal repair. OBSERVATIONS A 41-year-old man presented with clear continuous rhinorrhea through his left nostril for 5 days after repeated nasal swabbing for COVID-19. There were no obvious risk factors for spontaneous CSF leak. Computed tomography cisternography showed contrast accumulation in the left olfactory fossa and along the left nasal cavity. Such findings aligned with a preliminary diagnosis of CSF leakage through the left cribriform plate. Magnetic resonance imaging confirmed the presence of a CSF fistula between his left cribriform plate and superior nasal concha. The patient underwent endoscopic endonasal repair. CSF rhinorrhea ceased after the surgery, and no recurrence was noted during the 12-week postoperative follow-up period. LESSONS Although rare, iatrogenic CSF leakage can be a serious complication following COVID-19 nasal swab tests, especially when infection may cause significant neurological sequelae. Healthcare providers should become familiar with nasal cavity anatomy and be well trained in performing nasal swab tests.

Production of clinical form of chronic subdural hematoma in experimental animals

1972 ◽  
Vol 37 (5) ◽  
pp. 552-561 ◽  
Author(s):  
Satoru Watanabe ◽  
Hironobu Shimada ◽  
Shozo Ishii
Keyword(s):  
Cerebrospinal Fluid ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Subdural Space ◽  
Clinical Form ◽  
Content Type ◽  
Experimental Animals ◽  
Fine Print

✓ A method for producing a clinical form of experimental chronic subdural hematoma is reported. When blood is mixed with cerebrospinal fluid and incubated, a peculiar clot is formed which, when inoculated into the subdural space of dogs or monkeys, grows gradually. Histologically the capsule of the hematoma is comparable to that seen in human chronic subdural hematoma. In some animals progressive hemiparesis develops.

scholarly journals Giant Subgaleal cerebrospinal fluid leakage: An unusual complication of chronic subdural hematoma surgery

2017 ◽  
Vol 31 (3) ◽  
pp. 316-318
Author(s):  
Luis Rafael Moscote-Salazar ◽  
Hernando Raphael Alvis-Miranda ◽  
Amit Agrawal ◽  
Willem Calderon-Miranda ◽  
Alfonso Pacheco-Hernandez
Keyword(s):  
Cerebrospinal Fluid ◽  
Physical Examination ◽  
Mental Status ◽  
Subdural Hematoma ◽  
Neurological Disorder ◽  
Rare Case ◽  
Chronic Subdural Hematoma ◽  
Cerebrospinal Fluid Leakage ◽  
Unusual Complication ◽  
Fluid Leakage

Abstract We report a rare case of chronic subdural hematoma complicated with a Giant subgaleal cerebrospinal fluid leakage. Physical examination was performed with no alteration in mental status and no focal neurological disorder. The subdural hematoma was drained and two weeks later, patient was admitted to our hospital with a giant scalp swelling. Physical examination revealed a left parietal subcutaneous collection. The patient was reoperated with a correction in the fistula, he presented a satisfactory postoperative evolution. To our knowledge, this is the first report in literature of a chronic subdural hematoma with a complicated giant subgaleal cerebrospinal fluid leakage.

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