Why do chronic subdural hematomas continue to grow slowly and not coagulate? Role of thrombomodulin in the mechanism

Murakami, Hideki; Hirose, Yuichi; Sagoh, Masachika; Shimizu, Kazuhiro; Kojima, Masaru; Gotoh, Kazuhiro; Mine, Yutaka; Hayashi, Takuro; Kawase, Takeshi

doi:10.3171/jns.2002.96.5.0877

Cited by 100 publications

(71 citation statements)

References 21 publications

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“…Os pacientes com antecedente de traumatismo cranioencefálico apresentaram mortalidade significativamente inferior quando comparados com os pacientes sem tal antecedente, sugerindo que os hematomas espontâneos apresentam um prognós-tico menos favorável. Não foram encontrados estudos semelhantes com tais associações para comparações, porém os resultados obtidos ressaltam a necessidade de se avaliar a coagulação nos pacientes com diagnóstico de hematoma subdural crônico a fim de que se possa corrigir adequadamente as alterações encontradas e então submetê-los ao tratamento cirúrgico 24 . Além disso, deve ser ressaltado o fato de que a fisiopatologia dos hematomas subdurais crônicos não foi completamente elucidada e que provavelmente os resultados encontrados neste estudo são decorrentes dos mecanismos nela envolvidos e ainda obscuros.…”

Section: Discussionunclassified

Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma

Yasuda

Morita

Nishimori

et al. 2003

Arq. Neuro-Psiquiatr.

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RESUMO -O objetivo deste estudo é analisar a evolução de pacientes com hematoma subdural crônico em relação aos achados do coagulograma. Foram analisados 161 pacientes operados no Hospital das Clínicas-UNICAMP entre abril de 1994 e 2000. Foi detectado um predomínio do sexo masculino (86,3%), da cor branca (85,1%) e da faixa etária na quinta década (mediana 57 anos). O estudo mostrou mortalidade maior no período pós-operatório entre os pacientes com valores de RNI (international normalized ratio) superiores a 1,25 e/ou trombocitopenia (p<0,001 e p=0,004, respectivamente) e mortalidade menor para os pacientes com antecedente de traumatismo cranioencefálico (76%) (p=0,044). Os resultados ressaltam a importância da avaliação pré-operatória com o coagulograma a fim de se corrigir possíveis alterações.PALAVRAS-CHAVE: hematoma subdural crônico, coagulação, mortalidade. Chronic subdural hematoma: study of 161 patients and the relationship with coagulation abnormalitiesABSTRACT-The chronic subdural hematoma represents one of the most frequent types of intracranial hemorrhage. One hundred sixty one patients operated in the Clinical Hospital of State University of Campinas -SP (UNICAMP) from April 1994 to May 2000, were analyzed retrospectively in order to characterize the population and to study the importance of the pre-operative coagulation analysis in the outcome. The majority of the population was male (86%), white (85.1%) and in the fifth decade (median age: 57 years). A high mortality index in the postoperative period was found in patients with INR (international normalized ratio) values greater than 1.25 and/or thrombocytopenia (p<0.001 and p=0.004 respectively). Patients with previous head injury history (76%) showed a lower mortality (p=0.044). The results stand out the importance of the pre-operative evaluation with coagulation studies in order to correct possible abnormalities.KEY WORDS: chronic subdural hematoma, coagulation, mortality. O hematoma subdural crônico (HSC) representa uma das formas mais frequentes de hemorragia intracraniana 1 e é considerado uma lesão benigna, ainda que cronicamente progressiva 1-3 . O maior acometimento de pacientes idosos leva a uma variedade de dificuldades diagnósticas e terapêuticas devido a inespecificidade dos sintomas bem como patologias associadas 1,4 . Na maioria dos casos a evolução sem a instituição do tratamento cirúrgico pode ser fatal tanto pela compressão cerebral exercida pelo hematoma quanto pelas doenças associadas 5 . Por outro lado o diagnóstico precoce e a drenagem cirúrgica permitem a recuperação completa na maioria dos casos 1 .O HSC é caracterizado por uma coleção encapsulada e bem delimitada entre a dura máter e a membrana aracnóide contendo uma mistura de sangue fluido e coagulado de vários estágios 5,6 . A fisiopatologia do hematoma subdural crônico tem sido alvo de estudos desde a publicação de Virchow em 1857, em que descrevia com detalhes a lesão como uma paquimeningite hemorrágica 2,7,8 . Apesar das diversas teorias desenvolvidas desde então, a su...

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Section: Discussionunclassified

Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma

Yasuda

Morita

Nishimori

et al. 2003

Arq. Neuro-Psiquiatr.

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“…Factors associated with patient characteristics, such as old age, brain atrophy, poor performance status on admission, bleeding tendency, kidney diseases, liver dysfunction, chronic alcoholism, diabetes, epilepsy, dementia, hemodialysis, use of anticoagulants, antiplatelet and chemotherapeutic agents, intracranial hypotension (cerebrospinal fluid shunt surgery), have commonly been reported 1,16,20) . Factors associated with the pathogenesis of CSDH include large hematoma, bilateral CSDHs, septum formation or multiple membranes in the hematoma cavity, mixed-density and high-density hematoma on the CT scan 2,9,10,12,14,20) . Factors associated with surgery such as 1) insufficient drainage intraoperatively and postoperatively, 2) air collection in the hematoma cavity, 3) early surgery when the hematoma has a poorly developed capsule are thought *p-value reveals the relationship between low/iso-density group and high/mixed-density group, RG : recurrence group, NRG : non-recurrence group to increase the risk of recurrence 17) .…”

Section: Discussionmentioning

confidence: 99%

“…However, some patients suffer from the recurrence after surgery, with an incidence as variable as 3.7 to 30% 2,11,13,14) . Numerous factors influencing recurrence have been reported in the literature, but controversial findings are not uncommonly reported 1,2,12,17,19) . In our institute, one burr hole with closed system drainage has been the operative technique of choice over the last 20 years.…”

Section: Introductionmentioning

confidence: 99%

Clinical Analysis of Risk Factors Related to Recurrent Chronic Subdural Hematoma

Lee

Seo

et al. 2008

J Korean Neurosurg Soc

133

128

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“…7) Thrombomodulin is expressed on the sinusoidal vessels in the outer membrane, and the blood coagulation system is inhibited in subdural hematoma. 16) These findings indicate that these vessels are continuously injured and fail to heal, resulting in persistence of hemorrhage from the sinusoidal vessels. 16) In general, subacute intracerebral hematomas predominantly contain intracellular methemoglobin, appearing as high intensity on T 1 -weighted imaging and low intensity on T 2 -weighted imaging.…”

Section: Discussionmentioning

confidence: 96%

Subdural Hyperintense Band on Diffusion-Weighted Imaging of Chronic Subdural Hematoma Indicates Bleeding From the Outer Membrane

Kuwahara¹,

Fukuoka²,

Koan³

et al. 2005

Neurol. Med. Chir.(Tokyo)

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The diffusion-weighted magnetic resonance (MR) imaging characteristics of chronic subdural hematoma and the correlation between hematoma liquidity and apparent diffusion coefficient (ADC) were investigated in 26 consecutive patients, 16 males and 10 females aged 42 to 92 years (mean ± SD 73.3 ± 13.1 years), with 31 chronic subdural hematomas. The chronic subdural hematomas were divided into homogeneous, separate, and trabecular types based on diffusion-weighted MR imaging findings. Almost all hematomas were low intensity on diffusion-weighted imaging, and the mean ADC value was 1.81 ± 0.79 × 10 -3 mm 2 /sec. The high intensity areas in the subdural hematomas consisted of several types: high intensity line along the dura mater (subdural hyperintense band), high intensity along the intrahematoma septum, and laminar shape along the inner membrane. The subdural hyperintense bands accounted for almost all high intensity areas in the subdural hematomas. The mean ADC value of the high intensity areas was 0.76 ± 0.24 × 10 -3 mm 2 /sec, close to that of the normal brain. The subdural hyperintense bands were considered to be intracellular and/or extracellular methemoglobin based on the T 1 -and T 2 -weighted imaging and intraoperative findings. The subdural hyperintense band is an important finding indicating relatively fresh bleeding from the outer membrane. Diffusionweighted imaging shows liquid subdural hematoma as low intensity, and measurement of the ADC values can differentiate between liquid and solid components of the chronic subdural hematoma.

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Why do chronic subdural hematomas continue to grow slowly and not coagulate? Role of thrombomodulin in the mechanism

Cited by 100 publications

References 21 publications

Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma

Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma

Clinical Analysis of Risk Factors Related to Recurrent Chronic Subdural Hematoma

Subdural Hyperintense Band on Diffusion-Weighted Imaging of Chronic Subdural Hematoma Indicates Bleeding From the Outer Membrane

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