OBJECTIVETo probe the incidence, pathogenesis and clinical characteristics of traumatic subdural hydroma (TSH) developing into chronic subdural hematoma (CSDH).

METHODSWe retrospectively analyzed the clinical data of 32 patients with TSH developing into CSDH and reviewed related literature.

RESULTS16.7% of TSH developed into CSDH in this study. The time of evolution was from 22 to 100 days after head injury. All the patients were cured with hematoma drainage.

CONCLUSIONSTSH is one of the origins of CSDH. The clinical characteristics of TSH developing into CSDH follow that the ages of the patients are polarized, that the evolution often happens in the patients with small chronic hydromas and being treated conservatively, that the patients are usually injured deceleratedly and that the accompanying cerebral damage is often very mild.

Adolescent ; Adult ; Brain Injuries ; complications ; Child ; Chronic Disease ; Female ; Hematoma, Subdural ; etiology ; Humans ; Male ; Middle Aged ; Subdural Effusion ; complications ; etiology

We reviewed serial computed tomographic (CT) scans of 58 patients with traumatic subdural hygroma (SDG) to investigate its natural history. All were re-evaluated with a special reference to the size and density of SDG. Thirty-four patients (58.6%) were managed conservatively and 24 patients (41.4%) underwent surgery. The lesion was described as remained, reduced, resolved, enlarged and changed. Means of interval from injury to diagnosis and any changes in CT were calculated. SDGs were resolved in 12 (20.7%), reduced in 15 (25.9%), remained in 10 (17.2%), enlarged in 2 (3.4%), and changed into chronic subdural hematoma (CSDH) in 19 patients (32.8%). SDG was diagnosed at 11.6 days after the injury. It was enlarged at 25.5 days, remained at 46.0 days, reduced at 59.3 days, resolved at 107.5 days, and changed into CSDH at 101.5 days in average. SDGs were developed as delayed lesions, and changed sequentially. They enlarged for a while, then reduced in size. The final path of a SDG was either resolution or CSDH formation. Nearly half of SDGs was resolved or reduced within three months, however, 61.3% of unresolved or unreduced SDG became iso- or hyperdense CSDH. These results suggest that the unresolved SDG is the precursor of CSDH.
Adolescence ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Craniocerebral Trauma/complications ; Disease Progression ; Hematoma, Subdural, Chronic/radiography* ; Hematoma, Subdural, Chronic/pathology* ; Hematoma, Subdural, Chronic/etiology ; Human ; Infant ; Longitudinal Studies ; Lymphangioma/radiography ; Lymphangioma/pathology ; Lymphangioma/etiology ; Middle Age ; Subdural Effusion/radiography* ; Subdural Effusion/pathology* ; Subdural Effusion/etiology ; Tomography, X-Ray Computed*

The association of chronic subdural hematoma (CSDH) and arachnoid cyst (AC) is uncommon. We reported 2 juvenile athletes with CSDH associated with AC which occurred in their daily sports activities and reviewed the literature. Both of them were treated surgically, with satisfactory outcome. AC is a common predisposing factor in young patients with CSDH. The complication of intracranial bleeding is an indication for surgical management. Though there are still controversies in the treatment of asymptomatic AC, it is the consensus that the patients with AC should avoid violent sports so as to reduce the incidence of intracranial hemorrhage resulted from head injuries.
Adolescent ; Arachnoid Cysts ; complications ; Athletes ; Hematoma, Subdural, Chronic ; etiology ; surgery ; Humans ; Male ; Tomography, X-Ray Computed

Shaken baby syndrome (SBS) is a form of child abuse that can cause significant head injuries, of which subdural hematoma (SDH) is the most common manifestation. We report the MRI findings of chronic SDH in three cases of SBS, involving two-, three- and eight-month-old babies. The SDH signal was mostly low on T1-weighted images and high on T2-weighted images, suggesting chronic SDH. In chronic SDH, a focal high signal on T1-weighted images was also noted, suggesting rebleeding. Contrast-enhanced MRI revealed diffuse dural enhancement.
Brain/pathology ; Case Report ; *Child Abuse ; Chronic Disease ; Female ; Hematoma, Subdural/diagnosis/*etiology ; Human ; Infant ; *Magnetic Resonance Imaging ; Male

OBJECTIVETo probe into the incidence, mechanism and clinical characteristics of chronic subdural hematoma (CSDH) evolving from traumatic subdural effusion (TSE).

METHODSThe clinical materials of 32 patients with CSDH evolving from TSH were analyzed retrospectively and the correlative literature was reviewed.

RESULTS16.7% of the patients with TSH evolved into CSDH. The time of evolution was 22 - 100 days after head injury. All patients were cured with hematoma drainage.

CONCLUSIONSTSE is one of the origins of CSDH. The clinical characteristics of TSE evolving into CSDH include polarization of patient age, and chronic small effusion. The patients are usually injured deceleratedly and accompanied with mild cerebral damage.

Adolescent ; Adult ; Child ; Child, Preschool ; Chronic Disease ; Female ; Hematoma, Subdural ; etiology ; Humans ; Infant ; Male ; Middle Aged ; Retrospective Studies ; Subdural Effusion ; physiopathology ; Wounds and Injuries ; physiopathology

OBJECTIVETo investigate the role of matrix metalloproteinase (MMP) in the transformation of subdural effusion into chronic subdural hematoma.

METHODSThe clinical data of 8 patients with subdural effusion that transformed into chronic subdural hematoma were collected and MMP-2 and MMP-9 levels were detected in the sudural effusion, chronic subdural hematoma and capsules of hematoma using gelatin-zymography.

RESULTSMMP-2 and MMP-9 increased significantly in chronic subdural hematoma as compared with those in subdural effusion (P<0.01), and their levels were also significantly higher in the outer membrane than in the inner membrane of hematoma.

CONCLUSIONSubdural effusion is a risk factor for the occurrence of chronic subdural hematoma, in which process MMP plays a role as the promoting factor acting primarily in the outer membrane of the hematoma.

Adult ; Aged ; Chronic Disease ; Female ; Hematoma, Subdural ; enzymology ; etiology ; Humans ; Male ; Matrix Metalloproteinase 2 ; metabolism ; Matrix Metalloproteinase 9 ; metabolism ; Middle Aged ; Subdural Effusion ; complications ; enzymology

A 26-year-old male presented with a 6-day history of paroxysmal headache which was worsen with nausea and vomiting for 1 day. Head CT on admission revealed left chronic subdural hematoma with midline shift. An emergency Burr hole drainage for hematoma was performed. Headache recurred 6 days later. MRI of the brain revealed a diffuse thickening and a gadolinium-enhancement of the falx, cranial dura mater and tentorium cerebelli on the left side with pia mater involved. Lumber puncture showed increased intracranial pressure and elevated IgG level in cerebrospinal fluid. Histological examination of the biopsy specimen showed thickened, fibrotic dura with a sterile chronic inflammation. According to pathological examination, idiopathic hypertrophic cranial pachymeningitis was considered as the final diagnosis. Symptoms were improved with steroid pulse therapy.
Adult ; Biopsy ; Brain ; pathology ; Drainage ; Dura Mater ; pathology ; Hematoma, Subdural, Chronic ; etiology ; surgery ; Humans ; Hypertrophy ; diagnosis ; Immunoglobulin G ; cerebrospinal fluid ; Intracranial Hypertension ; etiology ; Magnetic Resonance Imaging ; Male ; Meningitis ; diagnosis ; Steroids ; administration & dosage ; therapeutic use ; Tomography, X-Ray Computed

OBJECTIVETo investigate the treatment of chronic subdural hematoma (CSDH) with burr-hole craniotomy in our hospital.

METHODSFrom January 2004 to December 2009, 398 patients with CSDH, 338 males and 60 females (male/female equal to 5.63/1), received burr-hole craniotomy in our hospital. The median age was 60 years with the mean age of (58.1 ± 18.1) years, (65.0 ± 14.5) years for females and (57.0 ± 18.2) years for males. Trauma history was determined in 275 patients (69.1%). Burr-hole craniotomy was performed under local anesthesia in 368 patients and general anesthesia in 30 patients. CSDH was classified into 3 groups according to the density on CT scan. Clinical data concerning etiologies, symptoms and signs, concomitant diseases, diagnosis, therapies and outcomes were investigated retrospectively. Patients'neurological status on admission and at discharge was also classified to judge the outcomes.

RESULTSGenerally, trauma history showed few differences between those over 60 years old and under 60 years old, but showed obvious differences when gender was taken into account. Totally 123 male patients (60.0% of 204 cases) suffering from head injuries were under 60 years, whereas 35 female patients (85.4% of 41 cases) with trauma histories were over 60 years. The duration from trauma to appearance of clinical symptoms was (84.0 ± 61.7) days (range, 0-1493 days). Traumatic accident was the leading etiology, other accompanying diseases such as cerebral vascular disease, hypertension, etc, were also predisposing factors. Commonly, the elderly presented with hemiplegia/hemidysesthesia/hemiataxia and the young with headache. Most CSDH patients (95.6%) treated with burr-hole craniotomy successfully recovered. However, postoperative complications occurred in 17 cases, including recurrence of CSDH in 15 cases, subdural abscess in 1 case and pneumonia in 3 cases.

CONCLUSIONBurr-hole craniotomy is an easy, efficient and reliable way to treat CSDH.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Craniotomy ; adverse effects ; methods ; Female ; Hematoma, Subdural, Chronic ; surgery ; Humans ; Infant ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Risk Factors ; Tomography, X-Ray Computed