Coagulation and fibrinolysis in chronic subdural hematoma

Abstract

In 19 patients with chronic subdural hematoma, coagulation and fibrinolysis in venous blood taken at the time of surgery and in the hematoma contents aspirated from chronic subdural hematoma were studied. Compared with coagulation results for venous blood, the hematoma contents demonstrated marked prolongation of the recalcification time, prothrombin time, and activated partial thromboplastin time, and marked reduction of clotting factor V, the hepaplastin test, prothrombin, and fibrinogen. Antithrombin III was also decreased, and fibrinopeptide A was increased in the hematomas. Fibrinolytic results demonstrated that both plasminogen and alpha 2-plasmin inhibitor were decreased, and both fibrinopeptide B beta 15-42 and fibrin and fibrinogen degradation products were increased in the hematomas. These findings indicate excessive activation of the clotting system, thrombin generation, and increased fibrinolytic activity occurring in the hematomas. From these results, excessive activation of both the clotting and fibrinolytic systems is emphasized to be the possible etiological factor for the origin and development of chronic subdural hematoma.

Acute Epidural-Like Appearance of an Encapsulated Solid Non-organized Chronic Subdural Hematoma -Case Report-

“…Failure of coagulation is due to the consumption of clotting factors within the chronic SDH, secondary to over-activation of both the intrinsic and extrinsic clotting pathways. 15,33,34) Moreover, the hematoma fluid has an anticoagulant effect when added to normal blood due to its high content of fibrinogen degradation products that inhibit the fibrin polymerization. 18,32,34) No measures of coagulation proteins and inhibitors were performed in the hematoma contents of our case, but we believe that an imbalance of the normal relationships between coagulant/anticoagulant factors could explain the absence of liquefaction of the subdural clot within the chronic SDH.…”

Subdural Hematoma Caused by Epithelioid Angiosarcoma Originating from the Skull

“…Imbalances between blood coagulation and fibrinolysis and/or thrombocytopenia resulting from advanced cancer are presumed pathomechanisms of SDH in such patients [1][2][3][4][5]. The most frequent cancer types associated with SDH include gastric, prostate, lung, and leukemia [2][3][4][5][6][7][8], all of which are relatively common among geriatric population.…”

“…Subdural hematoma (SDH) is a common disease in the elderly, and is frequently triggered by a minor trauma to the head [1]. Although cancers metastatic to the skull or dura may cause SDH in rare instances, the presence of underlying cancers has almost always been known for months to years [2][3][4][5][6][7][8].…”

The Shaken Baby Syndrome: An Odyssey -II Origins and Further Hypotheses-

“…In reviewing an extensive body of literature including published articles and clinical cases, it is noted that many of the infants supposedly shaken exhibit not acute, but chronic subdural hematomas, which themselves are known to expand and present by rebleeding without accompanying trauma. [15][16][17]31) It is the ultimate genesis of such hematomas, generated weeks or even months before clinical presentation, that is addressed here.…”