Pathogenesis of Chronic Subdural Hematoma

Goodell, Charles L.

doi:10.1001/archneur.1963.00460040099009

Cited by 48 publications

(8 citation statements)

References 19 publications

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“…Currently, there is appreciation that few cases of acute subdural hemorrhage evolve into chronic subdural hematomas (24, 55, 69). Experimental models are not able to reproduce a chronic subdural hematoma from acute subdural blood (39). It is now apparent that the great majority of chronic post‐traumatic subdural hematomas develop from subdural hygromas (56).…”

Section: Pathology Of Inflicted Traumatic Head Injurymentioning

confidence: 99%

Inflicted Traumatic Brain Injury in Infants and Young Children

Case¹

2008

Brain Pathology

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This article will discuss the subject of inflicted or abusive head injury in infants and young children. Inflicted neurotrauma is a very common injury and a frequent problem in attempting to distinguish between inflicted and accidental injury. Inflicted head injury occurs usually in the home in the presence of the individual who has inflicted the injury outside the view of unbiased witnesses. Distinguishing between inflicted and accidental injury may be dependent upon the pathological findings and consideration of the circumstances surrounding the injury. The most common finding in an inflicted head injury is the presence of subdural hemorrhage. Subdural hemorrhage may occur in a variety of distributions and appearances. The natural history of subdural bleeding and the anatomy of the "subdural" will be considered. The anatomy of the dura and its attachment to the skull and to the arachnoid determines how subdural bleeding evolves into the cleaved dural border cell layer and as well as how bridging veins are torn and anatomically where bleeding will occur. Different biomechanical mechanisms result in different distributions of subdural blood and these differences will be discussed.

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Section: Pathology Of Inflicted Traumatic Head Injurymentioning

confidence: 99%

Inflicted Traumatic Brain Injury in Infants and Young Children

Case¹

2008

Brain Pathology

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“…Inglis reported that haemorrhage in the subdural space was sufficient to initiate the proliferation of these dural border cells [ 9 ]. Many animal studies have shown that the presence of blood alone, in the subdural space, is not sufficient to initiate progression to a CSDH, although these models are limited by the nature that animals do not have other contributing factors found in human patients, such as cerebral atrophy [ 5 , 13 , 14 ]. However, we do know this to be true in humans as well, as shown by a study on 38 acute subdural haematoma patients where only eight (21%) progressed to form CSDHs [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy

Edlmann

Giorgi-Coll

Whitfield

et al. 2017

J Neuroinflammation

453

360

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Chronic subdural haematoma (CSDH) is an encapsulated collection of blood and fluid on the surface of the brain. Historically considered a result of head trauma, recent evidence suggests there are more complex processes involved. Trauma may be absent or very minor and does not explain the progressive, chronic course of the condition. This review focuses on several key processes involved in CSDH development: angiogenesis, fibrinolysis and inflammation. The characteristic membrane surrounding the CSDH has been identified as a source of fluid exudation and haemorrhage. Angiogenic stimuli lead to the creation of fragile blood vessels within membrane walls, whilst fibrinolytic processes prevent clot formation resulting in continued haemorrhage. An abundance of inflammatory cells and markers have been identified within the membranes and subdural fluid and are likely to contribute to propagating an inflammatory response which stimulates ongoing membrane growth and fluid accumulation. Currently, the mainstay of treatment for CSDH is surgical drainage, which has associated risks of recurrence requiring repeat surgery. Understanding of the underlying pathophysiological processes has been applied to developing potential drug treatments. Ongoing research is needed to identify if these therapies are successful in controlling the inflammatory and angiogenic disease processes leading to control and resolution of CSDH.

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“…20,22,27,34,49 The direct conversion of an acute SDH into a cSDH is infrequently observed in adult cases only and could not be simulated in animal experiments. 20,58,59…”

Section: Pathophysiologymentioning

confidence: 99%

Understanding Subdural Collections in Pediatric Abusive Head Trauma

Wittschieber

Karger

Pfeiffer

et al. 2018

AJNR Am J Neuroradiol

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Life-threatening physical abuse of infants and toddlers is frequently correlated with head injuries. A common variant of the abusive head trauma is the shaken baby syndrome. The present review article sheds light on subdural collections in children with abusive head trauma and aims at providing a recent knowledge base for various medical disciplines involved in diagnostic procedures and legal proceedings. To this end, the different subdural collection entities are presented and illustrated. The pathophysiologic background is explained. Differential and age-diagnostic aspects are discussed and summarized by tabular and graphic overviews. Two problematic constellations frequently occurring during initial CT investigations are evaluated: A mixed-density subdural collection does not prove repeated trauma, and hypodense subdural collections are not synonymous with chronicity. The neuroradiologic analysis and assessment of subdural collections may decisively contribute to answering differential diagnostic and forensic questions. In addition to more reference data, a harmonization of terminology and methodology is urgently needed, especially with respect to age-diagnostic aspects. ABBREVIATIONS: AHT ϭ abusive head trauma; BV ϭ bridging vein; cSDH ϭ chronic subdural hematoma; SDC ϭ subdural collection; SDE ϭ subdural effusion; SDH ϭ subdural hematoma; SDEm ϭ subdural empyema; SDHy ϭ subdural hygroma; SDHHy ϭ subdural hematohygroma I n light of serious physical, psychological, and legal consequences, physical child abuse attracts increasing attention in terms of health policy and health economy. 1-3 Head injuries represent the most frequent cause of lethal outcome and mainly relate to children within their first and second years of life. 4-6 Currently, the term "abusive head trauma" (AHT) is used for any nonaccidental or inflicted head injuries in pediatrics. 7-9 AHT has a worldwide incidence of 14-30/100,000 live births among children younger than 1 year of age. 5,10-13 Additionally, a high amount of underreporting has to be assumed because many cases are not identified due to subclinical courses, nonspecific symptoms, or missing medical consultation. 14 Meta-analyses on the outcome revealed an average mortality rate of around 20% among children younger than 2 years of age. 15 Survivors showed severe disability (eg, tetraplegia, epilepsy, or blindness) in ϳ34%,

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Pathogenesis of Chronic Subdural Hematoma

Cited by 48 publications

References 19 publications

Inflicted Traumatic Brain Injury in Infants and Young Children

Inflicted Traumatic Brain Injury in Infants and Young Children

Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy

Understanding Subdural Collections in Pediatric Abusive Head Trauma

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