Pathogenetic factors in chronic subdural haematoma and causes of recurrence after drainage

Abstract

The radiological aspect, pathology, treatment and results of 132 subdural haematomas observed in 100 patients, are discussed. The majority of these cases were characterized by a nonhomogenous CT scan picture, resulting from repeated bleeding in a previous subdural haematoma evolving to chronicity, or in a pre-existent subdural hygroma. Taking aspirin may have constituted a predisposing factor in 16% of our patients, whilst coagulation disturbances, including anticoagulant treatment, were observed in another 6%; ethylism was present in 11%. A traumatic origin was ascertained in 80% of the patients. The treatment consisted of burr hole evacuation and drainage in 91.5% of the haematomas, corresponding to 92% of the patients; it was eventually repeated once or twice in some cases. In 6% of the patients, a subduro-peritoneal drainage had to be placed ultimately and in 2%, a membranectomy had to be performed because the haematoma had become nearly completely fibrous. The necessity for repeated evacuation and eventual subduro-peritoneal drainage seems to depend mainly on a slow brain re-expansion in some elderly people, who are actually more frequently referred. Two patients died; one was deeply comatose and another in poor general condition. Morbidity in the 96 remaining patients, 2 being lost to follow-up, was 11%: 5% related to the haematoma or to the causal trauma, and 6% from other concomitant neurological disease. The functional result was satisfactory in 85%.

Diffusion Tensor Imaging in Chronic Subdural Hematoma: Correlation between Clinical Signs and Fractional Anisotropy in the Pyramidal Tract

“…The causes, clinical characteristics, and therapeutic management of CSDH are well established; however, the detailed physiology, including the mechanisms of appearance with motor dysfunction in patients, is still controversial. [1][2][3][4] Diffusion tensor imaging (DTI) reveals the tissue microstructure and architecture of white matter tracts, including pyramidal tracts, and extracts the principal diffusivities, mean diffusivities (MD), and fractional anisotropy (FA). Previously, it was reported that decreased FA in the pyramidal tracts on DTI was associated with secondary degeneration and could be a reliable measure of motor weakness.…”

Spontan Subdural Hematomu Olan Genç Hasta, Olgu Sunumu

“…Geçirilmiş travma öyküsü, antikoagülan kullanımı ve alkolizm ile subdural hematom oluşma riski artmaktadır. Subdural hematomu olan 100 hastanın incelendiği bir çalışmada hastaların %80'inde travma öyküsü, %22'sinde pıhtılaşmayı bozan ilaç kullanımı ve %11'inde alkolizm tespit edilmiştir (5). Subdural hematom yaşlılarda ve erkeklerde daha fazla görülmektedir.…”

“…Arteriyel kaynaklı kanama sonucu da oluşabilmektedir (2,3). Yaşlılarda, alkoliklerde, beyin atrofisi olanlarda, intrakranial anevrizması olanlarda, antikoagülan ilaç kullananlarda ve travma geçirenlerde subdural hematom daha sık görülmektedir (4)(5)(6)(7). Subdural hematom travmadan itibaren hematomun ortaya çıkma süresine göre akut, subakut ve kronik olarak sınıflandırılmaktadır (8).…”

Okulomotor Sinire Bası Yapan Hipofiz Adenomunun Anatomik Olarak İncelenmesi

“…Geçirilmiş travma öyküsü, antikoagülan kullanımı ve alkolizm ile subdural hematom oluşma riski artmaktadır. Subdural hematomu olan 100 hastanın incelendiği bir çalışmada hastaların %80'inde travma öyküsü, %22'sinde pıhtılaşmayı bozan ilaç kullanımı ve %11'inde alkolizm tespit edilmiştir (5 Maxeiner (1), ölüm sebepleri kafa travması olan 45 kişilik kadavra çalışmasında vakaların 2/3'ünde kontüzyonun eşlik ettiği kanama sebebiyle subdural hematom oluştuğunu; 1/3'ünde ise kontüzyon olmaksızın beynin yüzeyel damarlarının rüptürü sonucu subdural hematom oluştuğunu tespit etmiştir. Bu çalışmada bazı vakaların arteriyel orijinli olduğu tespit edilse de çoğunlukla köprü venlerinde rüptür olduğu gözlenmiştir.…”