Relations among traumatic subdural lesions

Abstract

Acute subdural hematoma (ASDH), chronic subdural hematoma (CSDH) and subdural hygroma (SDG) occur in the subdural space, usually after trauma. We tried to find a certain relationship among these three traumatic subdural lesions in 436 consecutive patients. We included all subdural lesions regardless of whether they were main or not. We evaluated the distribution, age incidence and interval from injury to diagnosis of these lesions, and the frequency of new subdural lesions in each lesion. ASDH constituted 68.6%, SDG 15.8%, and CSDH 15.6%, Age incidence of CSDH was similar to that of SDG, but differed from that of ASDH. Mean interval from injury to diagnosis was 0.4 days in ASDH, 13.4 days in SDG, and 51.6 days in CSDH. Focal brain injuries accompanied in 37.5% of ASDH, 5.8% of SDG, and no CSDH. In ASDH, 2 recurrent ASDHs, 17 SDGs and 9 CSDHs occurred. In SDG, 3 postoperative ASDHs and 8 CSDHs occurred. In CSDH, 2 postoperative ASDHs, 2 SDGs and 1 CSDH occurred. These results suggest that the origin of CSDH is not only ASDH, but also SDG in upto a half of cases. SDG is produced as an epiphenomenon by separation of the dural border cell layer when the potential subdural space is sufficient. A half of CSDHs may originate from ASDHs. ASDH may occur in CSDH by either a repeated trauma or surgery. Such transformation or development of new lesions is a function of a premorbid condition and the dynamics between the absorption capacity and expansile force of the lesion.

What Determines the Laterality of the Chronic Subdural Hematoma?

“…Then the left side of the cranium would be the top, when a man lies on his back. CSDHs frequently originate from SDGs 13,15,20) . SDGs usually locate on the top of the head 14) .…”

Subdural Hygromas in Abusive Head Trauma: Pathogenesis, Diagnosis, and Forensic Implications

“…86,87 Therefore, it has been suggested that repeated microhemorrhages possibly convert an SDHy into an expanding cSDH. 33,50,52,57,66 These pathogenetic considerations show why it is important for the forensic expert to differentiate between cSDH and SDHy. While cSDHs appear to be very rare and delayed consequences of subdural collections, SDHys can apparently develop delayed or rapidly.…”

“…The suggested process describes the conversion of acute SDH into cSDH via SDHy as an intermediate stage (blue pathway in Fig 2). 47,66 Because most acute SDHs resolve rapidly, reflecting the high levels of tissue thromboplastin in brain tissue and CSF, 67 this approach has been refined by other authors. During the dissolving of the acute SDH, especially if decreased intracranial pressure is present, the cleaved dura-arachnoid interface is assumed to remain as persistent posttraumatic space.…”

“…Moreover, experimental studies failed to reproduce cSDH from acute subdural blood. 83,84 It has also been reported that, based on histopathology 85 and CT, 66 chronic and acute SDH should actually be regarded as different entities. cSDH might therefore not be (at least not directly) the last stage of an old acute SDH.…”

Traumatic subdural hygroma: five cases with changed density and spontaneous resolution

“…These reports lack a uniform approach to method and segment time [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . Some authors have reported traumatic subdural hygroma presenting density modifications in the CT scan with change to chronic subdural hematoma 4,7,9,10,12,13,[15][16][17][18] . This study reports a series of South American adult patients with traumatic subdural hygroma, with emphasis on the evolution of clinical and CT scan data.…”