Subdural Levels of Interleukin 1-receptor Antagonist are Elevated in Patients with Recurrent Chronic Subdural Hematomas

Jensen, T. S.; Binderup, Tina; Olsen, Markus Harboe; Kjær, Andreas; Fugleholm, Kåre

doi:10.1007/s10753-023-01811-8

Cited by 6 publications

(2 citation statements)

References 51 publications

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“…I kombination med blødning fra nydannede blodkar bidrager hyperfibrinolysen til kontinuerlig blødning og ekspansion af haematomet. Fund af inflammationsmarkører i KSDH-vaesken tyder på igangvaerende inflammation [5]. En bred vifte af inflammatoriske celler producerer signalmolekylerne cytokiner, hvilket har effekt på den karakteristiske membrandannelse ved et KSDH [5].…”

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“…Fund af inflammationsmarkører i KSDH-vaesken tyder på igangvaerende inflammation [5]. En bred vifte af inflammatoriske celler producerer signalmolekylerne cytokiner, hvilket har effekt på den karakteristiske membrandannelse ved et KSDH [5]. Et KSDH er karakteriseret ved blødning enten som primaer initiator eller sekundaert ved overrivning af brovener undervejs i ekspansionen [2].…”

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Treatment of chronic subdural haematoma

Jensen,

Grønhøj,

Miscov

et al. 2024

Ugeskr Læger

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A further rise in chronic subdural haematoma (CSDH) prevalence is expected with an ageing population, and evidence-based guidelines are needed to direct treatment, while creating a platform for research. The Danish Chronic Subdural Hematoma Study (DACSUHS) has implemented the first Danish national CSDH guidelines in 2018 and have standardised CSDH management on a national level. Based on CSDH literature published between 2016 and 2022, these guidelines were updated in 2022. The updated guidelines are presented in this review.

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Treatment of chronic subdural haematoma

Jensen,

Grønhøj,

Miscov

et al. 2024

Ugeskr Læger

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The cellular composition of chronic subdural hematoma

Jensen,

Olsen,

Christoffersen

et al. 2024

Acta Neurochir

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Introduction The pathophysiology of chronic subdural hematoma (CSDH) remains to be fully understood. Basic knowledge of the composition and features of cells in the CSDH fluid may contribute to the understanding of the seemingly complex processes involved in CSDH formation and recurrence. This study is the first to examine the composition of cells and of cellular features in both systemic blood and subdural fluid from CSDH patients. We hypothesized that the cellular composition and features in the hematoma fluid may be; 1) different from that in the systemic blood; 2) different between patients with and without recurrence; 3) and different between the first and second operation in patients with recurrent CSDH. Methods Systemic blood and subdural hematoma fluid were collected from CSDH patients with and without recurrent CSDH at the time of primary and secondary surgery. Analyses of cells and cellular features included total number of white blood cells, erythroblasts, reticulocytes, platelets, neutrophilocytes, lymphocytes, monocytes, eosinophils, basophils, reticulocytes, immature granulocytes, mean corpuscular cell volume (MCV), mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, hemoglobin and hematocrit. Results Of the 85 included patients, 20 patients were operated for a recurrent CSDH within 90 days follow-up. All cells found in the systemic blood were present in the CSDH fluid, but the composition was different (p < 0.0001). MCV was higher in the hematoma fluid from the primary operation of patients later developing a recurrent CSDH compared to patients not developing recurrence (p = 0.009). Also, the percentage distribution of inflammatory cells in hematoma fluid from patients with recurrent CSDH was different between the first and second operation (p = 0.0017). Conclusion This study is the first to investigate the cellular composition of CSDH fluid. Compared to systemic blood and to a reference distribution, an increased number of immune cells were present in the hematoma fluid, supporting an inflammatory component of the CSDH pathophysiology. MCV was higher in the subdural fluid at time of the first operation of CSDH patients later developing recurrence. Clinical trial registration The study was approved by the Scientific Ethical Committee of the Capital Region of Denmark (Journal no. H-20051073.

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Urokinase Plasminogen Activator Receptor: An Important Focal Player in Chronic Subdural Hematoma?

Jensen,

Olsen,

Lelkaitis

et al. 2024

Inflammation

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Chronic subdural hematoma (CSDH) development involves inflammatory, angiogenetic, and fibrinolytic mechanisms, several components of which are now unraveled through intensive research. The urokinase plasminogen activator receptor (uPAR) is part of the plasminogen activator system and possesses inflammatory, angiogenetic, and fibrinolytic capabilities. As a first, this study aims to identify uPAR in the hematoma fluid, hematoma membrane, dura mater, and systemic blood from patients with CSDH and, if present, to investigate if the uPAR level at the time of surgery may be a predictor for later developing recurrent CSDH. uPAR expression in the hematoma membrane and dura mater was analyzed using immunohistochemistry and presented as the H-score of the positive immunostaining. The uPAR levels in the hematoma fluid and systemic blood were determined using a multiplex antibody bead kit (Luminex). Samples were collected at the time of the first CSDH surgery, and in the case of recurrent CSDH within 90 days, the samples were again collected at reoperation. A comparison of uPAR expression between the hematoma membrane and dura mater, as well as uPAR levels in systemic blood and hematoma fluid, was performed using the Wilcoxon rank sum test. We included 112 patients, 26 of whom had recurrent CSDH. The median hematoma uPAR level was 22,125 (14,845–33,237) and significantly higher than the median systemic blood level of 789 pg/L (465–2,088) (p < 0.001). Similarly, the uPAR level of the hematoma membrane was 14.3 (7.54–44.8) and significantly higher than the dural uPAR level of 0.81 (0.3–1.98) (p < 0.001). For the first time, we identified uPAR in the subdural fluid, hematoma membrane, dura mater, and systemic blood from patients with CSDH. The high expression of uPAR in the subdural fluid and hematoma membrane indicates that the mechanisms of CSDH are predominantly in the subdural fluid collection and surrounding hematoma membrane.

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Subdural Levels of Interleukin 1-receptor Antagonist are Elevated in Patients with Recurrent Chronic Subdural Hematomas

Cited by 6 publications

References 51 publications

Treatment of chronic subdural haematoma

Treatment of chronic subdural haematoma

The cellular composition of chronic subdural hematoma

Urokinase Plasminogen Activator Receptor: An Important Focal Player in Chronic Subdural Hematoma?

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