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

Shimizu, Yu; Park, Cheho; Tokuda, K.

doi:10.1016/j.clineuro.2020.105839

Cited by 12 publications

(12 citation statements)

References 20 publications

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“…Thus, we believe that the type of hematoma can affect the progression and recurrence of CSDH. A recent study has supported that the patients with gradation-density hematoma were an independent predictor for CSDH recurrence ( 26 ). What is more, the association between characteristics of hematoma and ABO blood type has also been reported in several pieces of literature.…”

Section: Discussionmentioning

confidence: 93%

Recurrence of Chronic Subdural Hematoma Is Independent of ABO Blood Type: A Retrospective Cohort Study

et al. 2022

Front. Neurol.

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ObjectiveA previous study with a limited number of patients has shown that blood type A was a risk factor in the recurrence of CSDH. The primary objective of this study was to investigate the association between the recurrence of CSDH and ABO blood type based on a larger sample size.MethodsThe authors reviewed in-patients with symptomatic CSDH from August 2011 to August 2021. Hospitalization information and data on long-term outcomes and recurrence among these patients were gathered. For all clinical variables, numbers (percentages) and mean ± standard deviations were used for categorical and continuous variables, respectively. For intergroup comparisons, the χ2 test or one-way ANOVA was carried out. Multivariable logistic regression analyses were performed to identify the association between CSDH recurrence and blood types.ResultsWe included 1,556 inpatients in this study. The recurrence rate of CSDH showed no differences among different blood types. In the multivariable logistic regression analyses, ABO blood type (A: OR, 1.064; 95% CI, 0.467–2.851, p = 0.793; B: OR, 0.682, 95% CI, 0.315–1.269, p = 0.164; AB: OR, 0.537, 95% CI, 0.426–1.861, p = 0.357) was not a significantly independent predictor of CSDH recurrence.ConclusionsOur study demonstrated that ABO blood type was not a risk factor in the recurrence of CSDH. Thus, we should not pay too much attention to ABO blood type in terms of CSDH recurrence.

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Section: Discussionmentioning

confidence: 93%

Recurrence of Chronic Subdural Hematoma Is Independent of ABO Blood Type: A Retrospective Cohort Study

et al. 2022

Front. Neurol.

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“…Previous studies have reported the mixed density as an independent risk factor for recurrence of CSDH (11,12). With the development of endoscopic technology, the advantages of its visualization help the surgeon to directly observe and clean up the hematoma, which may be conducive to improving the prognosis of patients.…”

Section: Discussionmentioning

confidence: 93%

“…The possible reason for this is that the hematoma is not completely liquefied in MDH, which makes the drainage tube easy to block after surgery and successively give rise to the poor drainage. Next, the residual hematoma would cause a widening of space between the dura mater and brain tissue, which may tear bridging vein and cause re-bleeding (5,11).…”

Section: Discussionmentioning

confidence: 99%

Rigid Neuroendoscopy Assisted Hematoma Resection Reduces the Recurrence Rate of Chronic Subdural Hematoma With Mixed Density: A Retrospective Analytic Cohort Study

et al. 2022

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BackgroundThe mixed density hematoma (MDH) has a high recurrence rate in chronic subdural hematoma (CSDH). This study adopted rigid neuroendoscopy assisted hematoma resection to evacuate CSDH and investigated its efficacy as compared with the traditional burr-hole craniostomy (BHC) in CSDH with mixed density.MethodsA retrospective cohort study was conducted at two centers between January 2015 and December 2020. The data of 124 patients who underwent BHC for CSDH with mixed density were collected and analyzed. A total of 41 patients underwent rigid neuroendoscopy assisted hematoma resection (neuroendoscopy group) and 83 patients were treated by the traditional BHC (control group). Follow-ups were conducted 6 months after the surgery.ResultsThere was no significant difference in the baseline characteristics and preoperative CT features between the two groups (p > 0.05). The neuroendoscopy group had a lower recurrence rate than the control group (p = 0.043). Besides the neuroendoscopy group had a higher rate of hematoma evacuation (p < 0.001), less pneumocephalus volume (p < 0.001), shorter hospital stay (p < 0.001) and better Markwalder score (p < 0.001) than the control group within 24–48 h after operation. However, there was no significant difference between the two groups in the incidence of pneumocephalus, Markwalder score (at discharge and 6 months after surgery) and mortality. Moreover, the operation time was longer in the neuroendoscopy group (p < 0.001).ConclusionsWhen compared with the traditional BHC, rigid neuroendoscopy assisted hematoma resection can better reduce the recurrence rate of CSDH with mixed density. Also, it surpassed the results obtained from BHC in reducing the volume of pneumocephalus, improving hematoma evacuation rate, promoting short-term neurological recovery, and shortening hospital stays.

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“…Certainly, the organized areas in the present case showed CT values of 40-80 HU, which fit the range of CT values for hematoma with active bleeding inside. One of the possible clues suggesting urgency is the presence of a gradation density inside the hematoma on brain CT, suggestive of persistent bleeding [4]. Three slices of brain CT images with gradation from another 74-year-old female subject with chronic subdural hematoma that required emergency burr-hole drainage are shown in Figure 1d-f. A gradation density hematoma with a smooth color change along the gravity direction was apparent, suggesting the presence of persistent, acute bleeding in the hematoma.…”

Section: Discussionmentioning

confidence: 99%

Organized Chronic Subdural Hematoma: A Condition Presenting Mixed-Density Hematoma without Gradation Density on Brain CT

et al. 2021

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Organized chronic subdural hematoma is a neurological condition characterized by organized clot formation inside the hematoma. Unlike nonorganized chronic subdural hematoma with persistent bleeding inside, organized subdural hematoma is often a nonurgent condition that does not require emergency drainage, unless progressive cerebral compression with neurological disturbances is present. However, as the CT values in organized clot formation and active bleeding fall in similar ranges, distinguishing these 2 conditions with different emergency levels based on brain CT alone is sometimes difficult. Here, we describe the case of a 78-year-old man with persistent nocturia who was referred to our hospital. He had a history of head trauma on the left side about 1 year ago, followed by neurosurgery at another hospital. Brain CT revealed a multiseptated subdural space and a mixed-density hematoma without gradation density on the contralateral side of the past head trauma region. Based on the lack of progressive neurological disturbances and the absence of gradation density in CT values inside the hematomas, his condition was judged as nonurgent, and emergency drainage was spared. One year after his first visit to our hospital, the patient experienced a normal life without any neurological disturbances, except for nocturia. The absence of gradation density in CT values along the gravity direction inside the organized hematoma may be a clue to estimate nonurgency without persistent active bleeding inside.

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

Cited by 12 publications

References 20 publications

Recurrence of Chronic Subdural Hematoma Is Independent of ABO Blood Type: A Retrospective Cohort Study

Recurrence of Chronic Subdural Hematoma Is Independent of ABO Blood Type: A Retrospective Cohort Study

Rigid Neuroendoscopy Assisted Hematoma Resection Reduces the Recurrence Rate of Chronic Subdural Hematoma With Mixed Density: A Retrospective Analytic Cohort Study

Organized Chronic Subdural Hematoma: A Condition Presenting Mixed-Density Hematoma without Gradation Density on Brain CT

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