Chronic subdural hematoma preceded by high-impact trauma: does the intensity of trauma influence the pathogenesis of traumatic chronic subdural hematoma?

Abstract

ABSTRACTof the meninges and the neo-membrane of hematoma have been recently clarified. Additionally, the roles of inflammatory, fibrinolytic, angiogenic, and coagulation-system factors in the CSDH have been investigated (3,7,8,12,22,32). Currently, CSDH is considered a chronic self-perpetuating inflammatory process involving the dura mater.Trauma is probably the most important risk factor for CSDH. Rupture of transversing veins by trauma is commonly known █ INTRODUCTION C hronic subdural hematoma (CSDH) is a commonly encountered neurosurgical disease that is more likely to occur under certain conditions, including advanced age, alcoholism, abnormal coagulation, dementia, seizure disorder, or after cerebrospinal fluid (CSF) diversion (13,17,18). Although the pathophysiology of CSDH has been controversial over the last several years, the ultrastructural anatomy AIm: The purpose of this study was to investigate whether the intensity of trauma influences the pathogenesis of traumatic chronic subdural hematoma (CSDH). mATERIAl and mEThODS: Thirty-one patients treated surgically for traumatic CSDH were divided into high-impact and lowimpact groups according to the intensity of trauma. They were respectively evaluated with respect to clinical and radiological findings at presentation, and the subdural concentrations of interleukin-6 (IL-6), interleukin-8 (IL-8), vascular endothelial growth factor (VEGF), basic fibroblast growth factor, and beta-trace protein (βTP) [a highly specific protein in the cerebrospinal fluid (CSF)] related to the pathogenesis of CSDH. If βTP (subdural fluid/serum) was >2, an admixture of CSF to the subdural fluid was indicated. RESUlTS:The βTP (subdural fluid/serum) was >2 in all patients with a traumatic CSDH. The mean concentration of subdural βTP in the high-impact group was higher than in the low-impact group (6.1 mg/L versus 3.9 mg/L), and the difference was statistically significant (p=0.02). In addition, mean concentrations of IL-6, IL-8 and VEGF were higher in the high-impact group, as compared to the low-impact group, though the differences did not reach statistical significance.CONClUSION: Trauma may be related to CSF leakage into the subdural space in CSDH, and the intensity of trauma may influence the amount of CSF leakage. Although there is no direct correlation between the amount of CSF leakage and other subdural molecules, the intensity of trauma may be associated with larger concentrations of molecules in traumatic CSDH.