Inflammation markers and risk factors for recurrence in 35 patients with a posttraumatic chronic subdural hematoma: a prospective study

Object. To evaluate the role of local inflammation in the pathogenesis and postoperative recurrence of chronic subdural hematoma (CSDH), the authors conducted an investigation in a selected group of patients who could clearly recall a traumatic event and who did not have other risk factors for CSDH. Inflammation was analyzed by measuring the concentration of the proinflammatory and inflammatory cytokines interleukin (IL)-6 and IL-8. The authors also investigated the possible relationship between high levels of local inflammation that were measured and recurrence of the CSDH. Methods. A prospective study was performed between 1999 and 2001. Thirty-five patients who could clearly recall a traumatic event that had occurred at least 3 weeks previously and who did not have risk factors for CSDH were enrolled. All patients were surgically treated by burr hole irrigation plus external drainage. The concentration of inflammatory cytokines was very high in the lesion, whereas it was normal in serum. In five cases in which recurrence occurred, concentrations of both IL-6 and IL-8 were significantly increased (p < 0.01) in comparison with cases without a recurrence. In a layering hematoma, the IL-6 and IL-8 concentrations were significantly higher (p < 0.05). Layering CSDHs were also significantly correlated with recurrence. Trabecular hematoma had the lowest cytokine levels and the longest median interval between trauma and clinical onset. The interval from trauma did not significantly influence recurrence, although it did differ significantly between the trabecular and layering CSDH groups. Concentrations of IL-6 and IL-8 in the CSDHs did not differ significantly in relation to either the age of the hematoma (measured as the interval from trauma) or the age of the patient. Conclusions. Brain trauma causes the onset of an inflammatory process within the dural border cell layer; high levels of inflammatory cytokines were significantly correlated with recurrence and layering CSDH. A prolonged postoperative antiinflammatory medicine given as prophylaxis may help prevent the recurrence of a CSDH.

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Chemokines as markers of local inflammation and angiogenesis in patients with chronic subdural hematoma: a prospective study

Acta Neurochirurgica ◽

10.1007/s00701-011-1203-2 ◽

2011 ◽

Vol 154 (1) ◽

pp. 113-120 ◽

Cited By ~ 41

Author(s):

Milo Stanisic ◽

Staale Petter Lyngstadaas ◽

Are Hugo Pripp ◽

Ansgar Oddne Aasen ◽

Karl-Fredrik Lindegaard ◽

...

Keyword(s):

Prospective Study ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Local Inflammation ◽

A Prospective Study

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Middle meningeal artery embolization for refractory chronic subdural hematoma

Journal of Neurosurgery ◽

10.3171/jns.2000.93.4.0686 ◽

2000 ◽

Vol 93 (4) ◽

pp. 686-688 ◽

Cited By ~ 46

Author(s):

Shinya Mandai ◽

Masaru Sakurai ◽

Yuzo Matsumoto

Keyword(s):

Liver Cirrhosis ◽

Subdural Hematoma ◽

Therapeutic Approach ◽

Chronic Subdural Hematoma ◽

Middle Meningeal Artery ◽

Artery Embolization ◽

Content Type ◽

Meningeal Artery ◽

Fine Print

✓ The authors present a case of refractory chronic subdural hematoma (CSH) in a 59-year-old man with coagulopathy due to liver cirrhosis. The patient was successfully treated by embolization of the middle meningeal artery after several drainage procedures. This new therapeutic approach to recurrent CSH is discussed.

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Chronic subdural hematoma simulating transient cerebral ischemic attacks

Journal of Neurosurgery ◽

10.3171/jns.1975.42.1.0101 ◽

1975 ◽

Vol 42 (1) ◽

pp. 101-103 ◽

Cited By ~ 15

Author(s):

Eldad Melamed ◽

Slvan Law ◽

Avinoam Reches ◽

Abraham Sahar

Keyword(s):

Subdural Hematoma ◽

Clinical Picture ◽

Chronic Subdural Hematoma ◽

Sensory Deficit ◽

Transient Ischemic Attacks ◽

Neurological Manifestations ◽

Content Type ◽

Pathophysiological Mechanisms ◽

Cerebral Ischemic ◽

Fine Print

✓ A patient is presented in whom chronic subdural hematoma simulated transient ischemic attacks. The neurological manifestations were those of recurrent, transient episodes of expressive dysphasia preceded by focal sensory deficit. Various pathophysiological mechanisms which could have caused the unusual clinical picture are briefly considered.

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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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Brain scans and echoencephalography in the diagnosis of chronic subdural hematoma

Journal of Neurosurgery ◽

10.3171/jns.1974.40.3.0347 ◽

1974 ◽

Vol 40 (3) ◽

pp. 347-350 ◽

Cited By ~ 12

Author(s):

Sheldon R. Hurwitz ◽

Samuel E. Halpern ◽

George Leopold

Keyword(s):

Cerebral Angiography ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Content Type ◽

Brain Scans ◽

Subdural Hematomas ◽

Fine Print

✓ Eighteen patients with chronic subdural hematomas were studied by both brain scans and echoencephalography. All cases were verified by cerebral angiography. Brain scanning was accurate in predicting hematomas in 93% of the cases, and echoencephalography in 44%. When hematomas were bilateral or when frontal clots caused no shift in the diencephalic midline, the routine echoencephalogram often was negative. The two procedures are complementary, and serial studies may be helpful in the study of changing clinical situations.

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The management of “asymptomatic” epidural hematomas

Journal of Neurosurgery ◽

10.3171/jns.1989.70.3.0392 ◽

1989 ◽

Vol 70 (3) ◽

pp. 392-396 ◽

Cited By ~ 82

Author(s):

Neville W. Knuckey ◽

Steven Gelbard ◽

Mel H. Epstein

Keyword(s):

Risk Factors ◽

Epidural Hematoma ◽

Skull Fracture ◽

Content Type ◽

Mortality And Morbidity ◽

Management Protocol ◽

Major Vessel ◽

Low Incidence ◽

A Prospective Study ◽

Fine Print

✓ Standard neurosurgical management mandates prompt evacuation of all epidural hematomas to obtain a low incidence of mortality and morbidity. This dogma has recently been challenged. A number of authors have suggested that in selected cases small and moderate epidural hematomas may be managed conservatively with a normal outcome and without risk to the patient. The goal of this study was to define the clinical parameters that may aide in the management of patients with small epidural hematomas who were clinically asymptomatic at initial presentation because there was no clinical evidence of raised intracranial pressure or focal compression. A prospective study was conducted of 22 patients (17 males and five females) aged from 1 to 71 years, who had a small epidural hematoma diagnosed within 24 hours of trauma and were managed expectantly. Of these, 32% subsequently required evacuation of the epidural hematoma 1 to 10 days after the initial trauma. Analysis of the patients revealed that age, sex, Glasgow Coma Scale score, and initial size of the hematoma are not risk factors for deterioration. However, deterioration was seen in 55% of patients with a skull fracture transversing a meningeal artery, vein, or major sinus, and in 43% of those undergoing computerized tomography (CT) within 6 hours of trauma. In contrast, only 13% of patients in whom the diagnosis of a small epidural hematoma was delayed over 6 hours subsequently required evacuation of the epidural collection. Of patients with both risk factors, 71% required evacuation of the epidural hematoma. None of the patients suffered neurological sequelae attributable to this management protocol. It was concluded that patients with a small epidural hematoma, a fracture overlaying a major vessel or major sinus, and/or who are diagnosed less than 6 hours after trauma are at risk of subsequent deterioration and may require evacuation. Conversely, patients without these risk factors may be managed conservatively with repeat CT and careful neurological observation, because of the low risk of delayed deterioration.

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Chronic subdural hematoma presenting as spontaneous subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.1985.63.5.0691 ◽

1985 ◽

Vol 63 (5) ◽

pp. 691-692 ◽

Cited By ~ 11

Author(s):

Zbigniew Kotwica ◽

Jerzy Brzeziński

Keyword(s):

Subarachnoid Hemorrhage ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Clinical Findings ◽

Content Type ◽

Acute Subarachnoid Hemorrhage ◽

Spontaneous Subarachnoid Hemorrhage ◽

Fine Print

✓ Six cases of chronic subdural hematoma presenting with the clinical findings of acute subarachnoid hemorrhage are reported. No systemic or focal cause for the bleeding was found, and possible mechanisms are discussed.

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Experimental chronic subdural hematoma in mice

Journal of Neurosurgery ◽

10.3171/jns.1987.67.5.0710 ◽

1987 ◽

Vol 67 (5) ◽

pp. 710-716 ◽

Cited By ~ 8

Author(s):

Hisashi Aikawa ◽

Kinuko Suzuki

Keyword(s):

Body Weight ◽

Blood Vessels ◽

Subdural Hematoma ◽

Intraperitoneal Injection ◽

Intraventricular Hemorrhage ◽

Chronic Subdural Hematoma ◽

Content Type ◽

Single Intraperitoneal Injection ◽

Thin Walled ◽

Fine Print

✓ A new experimental model of chronic subdural hematoma in mice is described. A single intraperitoneal injection of 6-aminonicotinamide (25 mg/kg body weight) on the 5th postnatal day induced hydrocephalus in mice with almost 100% success. Approximately 60% of the mice spontaneously developed intracranial hemorrhage 20 days after the injection. About 1 week after the hemorrhage, a lens-shaped or spherical subdural hematoma was observed, accompanied by marked dilatation of the lateral ventricles and intraventricular hemorrhage. Histological examination revealed that the hematoma contained well-organized outer and inner membranes. Fresh hemorrhage surrounded by many hemosiderin-laden macrophages was seen at the margin of the hematoma adjacent to the organizing outer membrane, in which many fibroblasts and blood vessels were noted. The inner membrane of the hematoma was made up of several tiers of flattened cells with thin-walled blood vessels. The gross morphology and histology of these hematomas closely resembled those of human chronic subdural hematoma.

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Production of clinical form of chronic subdural hematoma in experimental animals

Journal of Neurosurgery ◽

10.3171/jns.1972.37.5.0552 ◽

1972 ◽

Vol 37 (5) ◽

pp. 552-561 ◽

Cited By ~ 54

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.

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