The Outer Neomembrane of Chronic Subdural Hematoma

Killeffer, James A.; Killeffer, Fred A.; Schochet, Sydney S.

doi:10.1016/s1042-3680(18)30102-5

Cited by 62 publications

(31 citation statements)

References 28 publications

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“…After undergoing encapsulation, chronic SDHs usually experience gradual enlargement through repetitive episodes of bleeding from the outer membrane. 16,28) Thickness and composition of the neomembranes varies greatly from case to case depending on the age of the hematoma, although complete formation of the fibrous capsule usually requires 3 to 4 weeks. 7,30) A majority of chronic SDHs are liquid when diagnosed and can be treated by evacuation-aspiration through burr holes.…”

Section: Discussionmentioning

confidence: 99%

“…Blood vessels of this type are a constant finding within the neomembranes of mature chronic SDHs and are considered to be the main source of repetitive bleedings into these hematomas. 8,16,36) The elevated amount of eosinophils in the neomembranes of this hematoma could also have been involved, because degranulation of these cells releases angiogenic and fibrinolytic factors involved in both the formation of fragile sinusoidal vessels and their tendency to spontaneous bleeding. 2) Finally, the patient's history of hypertension could have favored the bleeding tendency of these fragile vessels.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Prieto

Pascual

Subhi-Issa

et al. 2010

Neurol. Med. Chir.(Tokyo)

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We report the exceptional case of an encapsulated solid non-organized chronic subdural hematoma (SDH) in a 67-year-old woman that was admitted with acute hemiplegia followed by rapid deterioration in consciousness 5 months after a minor head trauma. Computed tomography (CT) showed an extracerebral biconvex shaped hyperdense mass that led to the misdiagnosis of an acute epidural hematoma. Urgent craniotomy revealed an encapsulated mass filled with solid fresh clot in the subdural space. Complete evacuation of this SDH, including both its inner and outer membranes, was achieved, and the patient recovered successfully. Histological analysis confirmed that the content of the hematoma corresponded to a newly formed clot that was enclosed between an inner membrane, composed of two collagen layers, and an outer membrane with a three layered structure. Chronic SDH may seldom present as an encapsulated solid non-organized lesion that consists of a fibrous capsule enclosing a fresh clot and lacking the thick fibrous septations that typically connect the inner and outer membranes of organized chronic SDH. This entity mimics the clinical course and radiological appearance of acute epidural hematomas and should be considered in the differential diagnosis of extracerebral hyperdense biconvex shaped lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Prieto

Pascual

Subhi-Issa

et al. 2010

Neurol. Med. Chir.(Tokyo)

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“…Neomembranes of subdural hematoma presumably arise in response to cleavage of DBC layer [4]. The capsule of subdural hematoma consists of an outer thicker portion adjacent to the dura and an inner thinner part that is apposed to the arachnoid barrier cell layer [10]. Morphologic studies have shown that the outer hematoma neomembrane contains elements that are not found in the normal dural border cell layer, e. g., loose collagen fibers, large capillaries, smooth muscle cells, eosinophils and inflammatory cells [3,10,24].…”

Section: Discussionmentioning

confidence: 99%

“…The capsule of subdural hematoma consists of an outer thicker portion adjacent to the dura and an inner thinner part that is apposed to the arachnoid barrier cell layer [10]. Morphologic studies have shown that the outer hematoma neomembrane contains elements that are not found in the normal dural border cell layer, e. g., loose collagen fibers, large capillaries, smooth muscle cells, eosinophils and inflammatory cells [3,10,24]. We found a marked increase of the concentrations of PICP and PIIINP and a modest increase in the concentration of ICTP in the subdural hematoma fluid after head injury showing that the dura is an active site for collagen synthesis.…”

Section: Discussionmentioning

confidence: 99%

Procollagen propeptides in chronic subdural hematoma reveal sustained dural collagen synthesis after head injury

2009

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“…Beneath the arachnoid membrane is the subarachnoid space, which contains vessels and cerebrospinal fluid. Hemorrhage into this space is called SAH (113). Finally, the brain is tightly covered by pia mater, which delimits the inner extent of the subarachnoid space.…”

Section: Interhemispheric Extraaxial Hemorrhagementioning

confidence: 99%

From the Archives of the AFIP

et al. 2003

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In the United States, roughly one of every 100 children is subjected to some form of neglect or abuse; inflicted injury is responsible for approximately 1,200 deaths per year. Child physical abuse may manifest as virtually any injury pattern known to medicine. Some of the injuries observed in battered children are relatively unique to this population (especially when observed in infants) and therefore are highly suggestive of nonaccidental, or inflicted, injury. Worrisome injuries include rib fracture, metaphyseal fracture, interhemispheric extraaxial hemorrhage, shear-type brain injury, vertebral compression fracture, and small bowel hematoma and laceration. As noted, however, virtually any injury may be inflicted; therefore, careful consideration of the nature of the injury, the developmental capabilities of the child, and the given history are crucial to determine the likelihood that an injury was inflicted. The majority of these injuries are readily detectable at imaging, and radiologic examination forms the mainstay of evaluation of child physical abuse. Detection of metaphyseal fracture (regarded as the most specific radiographically detectable injury in abuse) depends on high-quality, small field-of-view radiographs. The injury manifests radiographically as a lucent area within the subphyseal metaphysis, extending completely or partially across the metaphysis, roughly perpendicular to the long axis of the bone. Acute rib fractures (which in infants are strongly correlated with abuse) appear as linear lucent areas. They may be difficult to discern when acute; thus, follow-up radiography increases detection of these fractures. For skull injuries, radiography is best for detecting fractures, but computed tomography and magnetic resonance imaging best depict intracranial injury.

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The Outer Neomembrane of Chronic Subdural Hematoma

Cited by 62 publications

References 28 publications

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

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

Procollagen propeptides in chronic subdural hematoma reveal sustained dural collagen synthesis after head injury

From the Archives of the AFIP

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