Relationship between tissue plasminogen activator, plasminogen activator inhibitor and CT image in chronic subdural hematoma

Lim, Dong Jun; Chung, Yong Gu; Park, Youn Kwan; Song, Jun Hyuk; Lee, Hoon Kap; Lee, Ki Chan; Chu, Jeong Wha; Yang, Yong Son

doi:10.3346/jkms.1995.10.5.373

Cited by 25 publications

(13 citation statements)

References 3 publications

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“…15;16 The concentration of tissue plasminogen activator (t-PA) is highest and the concentration of plasminogen activator inhibitor (PAI) is lowest in mixed-density CSDHs. 17 This suggests that fibrinolytic activity is highest in mixed-density CSDHs. Highmolecular weight fibrin degradation products (FDPs) inhibit coagulation, platelet aggregation, fibrin polymerization, and promote the activity of t-PA. 17 The FDPs also have angiogenic activity and stimulate fibroblast proliferation, possibly contributing to CSDH membrane formation.…”

Section: Discussionmentioning

confidence: 97%

“…17 This suggests that fibrinolytic activity is highest in mixed-density CSDHs. Highmolecular weight fibrin degradation products (FDPs) inhibit coagulation, platelet aggregation, fibrin polymerization, and promote the activity of t-PA. 17 The FDPs also have angiogenic activity and stimulate fibroblast proliferation, possibly contributing to CSDH membrane formation. 18 The FDP level is highest in the mixed-density group.…”

Section: Discussionmentioning

confidence: 97%

“…The volumes of CSDHs on brain CT were largest among mixed-density CSDHs. 17 Kwon et al 24 reported that mixed-density CSDHs had the lowest mean post-operative drainage volume of 151 € 86 ml compared with 413 € 269 ml for low-density and 348 € 257 ml for isodense CSDHs. This indicates that mixed-density lesions occupied larger spaces and had larger mass effects on brain parenchyma.…”

Section: Discussionmentioning

confidence: 98%

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Early post-operative seizures after burr-hole drainage for chronic subdural hematoma: correlation with brain CT findings

Chen

Kuo

Lin

et al. 2004

Journal of Clinical Neuroscience

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Early post-operative seizures after burr-hole drainage for chronic subdural hematoma: correlation with brain CT findings

Chen

Kuo

Lin

et al. 2004

Journal of Clinical Neuroscience

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“…59 60 The high concentration of vascular endothelium derived growth factor (VEGF), for example, could be involved in the formation of the haematoma membranes. Furthermore, the haematoma fluid contains inflammatory mediators [61][62][63] and fibrinolytic factors [64][65][66][67][68][69][70][71][72][73][74][75][76] which all may play a role in the further development of the haematoma. The risk of recurrence is increased when the concentration of fibrinolytic factors remains high in the postoperative drainage fluid.…”

Section: Discussionmentioning

confidence: 99%

Outcome of contemporary surgery for chronic subdural haematoma: evidence based review

Weigel

2003

Journal of Neurology, Neurosurgery & Psychiatry

540

375

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Objective: To evaluate the results of surgical treatment options for chronic subdural haematoma in contemporary neurosurgery according to evidence based criteria. Methods: A review based on a Medline search from 1981 to October 2001 using the phrases "subdural haematoma" and "subdural haematoma AND chronic". Articles selected for evaluation had at least 10 patients and less than 10% of patients were lost to follow up. The articles were classified by three classes of evidence according to criteria of the American Academy of Neurology. Strength of recommendation for different treatment options was derived from the resulting degrees of certainty. Results: 48 publications were reviewed. There was no article that provided class I evidence. Six articles met criteria for class II evidence and the remainder provided class III evidence. Evaluation of the results showed that twist drill and burr hole craniostomy are safer than craniotomy; burr hole craniostomy and craniotomy are the most effective procedures; and burr hole craniostomy has the best cure to complication ratio (type C recommendation). Irrigation lowers the risk of recurrence in twist drill craniostomy and does not increase the risk of infection (type C recommendation). Drainage reduces the risk of recurrence in burr hole craniostomy, and a frontal position of the drain reduces the risk of recurrence (type B recommendation). Drainage reduces the risk of recurrence in twist drill craniostomy, and the use of a drain does not increase the risk of infection (type C recommendation). Burr hole craniostomy appears to be more effective in treating recurrent haematomas than twist drill craniostomy, and craniotomy should be considered the treatment of last choice for recurrences (type C recommendation). Conclusions: The three principal techniques-twist drill craniostomy, burr hole craniostomy, and craniotomy-used in contemporary neurosurgery for chronic subdural haematoma have different profiles for morbidity, mortality, recurrence rate, and cure rate. Twist drill and burr hole craniostomy can be considered first tier treatment, while craniotomy may be used as second tier treatment. A cumulative summary of data shows that, overall, the postoperative outcome of chronic subdural haematoma has not improved substantially over the past 20 years. C hronic subdural haematoma of the elderly is nowadays often considered to be a rather benign entity, ignoring its relatively high mortality and morbidity. When Virchow first described "pachymeningitis haemorrhagica interna," however, it was considered a fatal disorder.1 Over the past 150 years, a dramatic improvement in outcome was achieved following better understanding of the pathophysiology, the introduction of modern imaging methods, and refinement of operative techniques.2 However, mortality of up to 13% is still reported in contemporary literature, [3][4][5][6] which may reflect the fact that up to four deaths a year are related to this condition in a typical neurosurgical department. Although this is one of the most frequent...

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“…Previous studies have suggested that local anticoagulation and inflammatory changes may influence the pathogenesis of CSDH, although the process has not been clearly elucidated. 16,28,32,35,38) The transformation of traumatic subdural hygromas into CSDH has been discussed in several studies. 7,23) Computed tomography (CT) of CSDH often shows changes in the components of hematomas, and there may be an association between CT appearance and altered cytokine levels in CSDH.…”

Section: Introductionmentioning

confidence: 99%

Measurement of Inflammatory Cytokines and Thrombomodulin in Chronic Subdural Hematoma

Kitazono

Satoh

Onda

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Inflammation and the coagulation system may influence the genesis of chronic subdural hematoma (CSDH). The appearance of CSDH on computed tomography (CT) varies with the stage of the hematoma. This study investigated the pathogenesis and the recurrence of CSDH by comparing cytokine levels with the CT features of CSDH in 26 patients with 34 CSDHs who underwent single burr-hole surgery at our hospital between October 2004 and November 2006. The hematoma components removed during the procedure were examined, and the hematoma serum levels of cytokines measured such as thrombomodulin (TM), interleukin-6 (IL-6), tumor necrosis factor-a (TNFa), and interleukin-10 (IL-10). Using CT, mixed density hematomas were distinguished from other homogeneous hematomas, and found that the TM level was significantly higher in mixed density hematomas than in homogeneous hematomas (p ＝ 0.043). Mixed density hematomas were classified into three subtypes (laminar, separated, and trabecular hematomas). The TM level was significantly higher in laminar and separated hematomas than in other hematomas (p ＝ 0.01). The levels of IL-6, TNFa, and IL-10 were extremely high, but showed no significant differences in relation to the CT features. Mixed density hematomas had high recurrence rate, as reported previously, and TM level was high in mixed density hematomas such as laminar and separated mixed density hematomas. The present findings suggest that the types of CSDH associated with high TM levels tend to have higher recurrence rate.

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Relationship between tissue plasminogen activator, plasminogen activator inhibitor and CT image in chronic subdural hematoma

Cited by 25 publications

References 3 publications

Early post-operative seizures after burr-hole drainage for chronic subdural hematoma: correlation with brain CT findings

Early post-operative seizures after burr-hole drainage for chronic subdural hematoma: correlation with brain CT findings

Outcome of contemporary surgery for chronic subdural haematoma: evidence based review

Measurement of Inflammatory Cytokines and Thrombomodulin in Chronic Subdural Hematoma

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