Platelet-activating factor (PAF) and the development of chronic subdural haematoma

Abstract

Platelet activating factor (PAF) content and PAF-acetylhydrolase (PAFAH) activity were measured in the plasma and haematoma of 34 chronic subdural haematoma (CSH) patients. The plasma PAF level in patients with CSH was higher than that in healthy controls. Although there was no correlation between the plasma PAF levels and the interval between the onset of symptoms and the day of sampling, namely, the interval after bleeding, the haematoma PAF level gradually decreased according to the interval after the onset of symptoms. There was no difference between plasma PAFAH activity in patients with CSH and that in healthy controls, and haematoma enzyme activity gradually increased correlated with the interval between the onset of symptoms and surgery. In addition, the localization of PAF in haematoma capsules was histochemically determined. PAF was solely localized to the peri-sinusoidal vessels in the outer membrane of haematoma capsules. Based on these biochemical and histochemical studies, we speculated that PAF may play a role in the development of chronic subdural haematomas.

Inflammation markers and risk factors for recurrence in 35 patients with a posttraumatic chronic subdural hematoma: a prospective study

“…16,43 Once this intradural space has been created, cells in the dural border begin to proliferate, representing the first step in the pathogenesis of CSDH. 20,31,32,40,58 In fact, as these mesenchymal cells proliferate and differentiate, they form a sort of inflammatory capsule or membrane around the blood clots or CSF, called the external or outer membrane. 29,31,32,38,42 The outer membrane of the CSDH is composed of a sort of granulation tissue in which several types of inflammatory cells-mast cells, eosinophils, neutrophils, monocytes, macrophages, endothelial cells, and fibroblasts-are continuously activated and recruited.…”

“…29,31,32,38,42 The outer membrane of the CSDH is composed of a sort of granulation tissue in which several types of inflammatory cells-mast cells, eosinophils, neutrophils, monocytes, macrophages, endothelial cells, and fibroblasts-are continuously activated and recruited. [8][9][10][16][17][18]20,22,44,53 This membrane also contains immature vessels and connective fibers and, on the whole, constitutes a source of inflammatory, angiogenic, fibrinolytic, and coagulation factors. [19][20][21][22][23]25,33,46,[49][50][51]55,57,58 Immunohistochemical analysis recently demonstrated a strong expression of the cytokine VEGF in most inflammatory cells infiltrating the neomembranes of CSDH, mainly in plasma cells and tissue macrophages.…”

“…[8][9][10][16][17][18]20,22,44,53 This membrane also contains immature vessels and connective fibers and, on the whole, constitutes a source of inflammatory, angiogenic, fibrinolytic, and coagulation factors. [19][20][21][22][23]25,33,46,[49][50][51]55,57,58 Immunohistochemical analysis recently demonstrated a strong expression of the cytokine VEGF in most inflammatory cells infiltrating the neomembranes of CSDH, mainly in plasma cells and tissue macrophages. 55 Furthermore, the role of VEGF in neovascularization and vascular hyperpermeability has been documented, confirming previous studies in which it was stated that inflammation is responsible for angiogenesis of the outer membrane.…”

“…6-11,14-17,19-26, 31-33,37,42,47,56 Recently, several papers concerning the ultrastructural anatomy of the meninges and the neomembrane of the hematoma, and the role of inflammatory (cytokines, bradykinin, and kinin), fibrinolytic (tissue plasminogen activator, plasminogen, and fibrin degradation products), angiogenic (VEGFs), and coagulation-system factors have really clarified this complicated topic. [7][8][9][10][11]16,[19][20][21][22][23]33,46,50,51,55,57 Currently, CSDH is considered a chronic self-perpetuating inflammatory process that involves the dura mater. 17,38,39,50,51,54,56 Surgery is the treatment of choice.…”

Local and systemic pro-inflammatory and anti-inflammatory cytokine patterns in patients with chronic subdural hematoma: a prospective study

“…When CSF or extravasated blood gathers into the restricted area of the dural border cell layer [3][4][5], it evokes local aseptic inflammatory- [6][7][8][9][10] and inflammationinduced angiogenic reactions [8,[11][12][13][14][15][16][17]. The result is production of granulation tissue, consisting of numerous newly formed and permeable blood vessels, inflammatory cells, proliferating fibroblasts corresponding to ''boundary cells'' and smooth muscle cells, that takes place primarily on the inner dural surface [3,[18][19][20].…”