Golden J, Frim DM, Chapman PH, Vonsattel JP. Ushio-Fukai M, Alexander RW. Chronic subdural haematoma occurs more commonly in the elderly, as their brains tend to shrink a little and the veins running from the brain to the sinuses . found that eotaxin 3, an eosinophil-specific chemoattractant, is present in high concentrations within the hematoma [72]. Doncaster East Wu D, Ren Z, Pae M, Guo W, Cui X, Merrill AH, et al. The typical CSH patient is a male in his seventh decade. Since VEGF increases vascular permeability via this pathway [97], it may explain exsudation which is one of the main mechanisms of hematoma enlargement. Oxygenated hemoglobin is diamagnetic, appearing hypointense on T1- and hyperintense on T2-weighted images. Pericellular proteases in angiogenesis and vasculogenesis. Both mechanisms might explain the unmatured phenotypic characteristics of the majority of vessels within the neomembranes [3]. Komiyama K, Tosaka M, Shimauchi-Ohtaki H, Aihara M, Shimizu T, Yoshimoto Y. Computed tomography findings after head injury preceding chronic subdural hematoma. In1). Relationship between tissue plasminogen activator, plasminogen activator inhibitor and CT image in chronic subdural hematoma. Associations of Omega-3 fatty acids with brain morphology and volume in cognitively healthy older adults: a narrative review. Traumatic subdural hematoma with particular reference to the latent interval. Sato M, Muragaki Y, Saika S, Roberts AB, Ooshima A. Subsequently, it was shown that hematomas of the layering type have a higher tendency to recur [43, 44]. Impact on cognitive improvement following burr hole evacuation of chronic subdural hematoma: a prospective observational study. Sokolowski KM, Koprowski S, Kunnimalaiyaan S, Balamurugan M, Gamblin TC, Kunnimalaiyaan M. Potential molecular targeted therapeutics: role of PI3-K/Akt/mTOR inhibition in cancer. With that regard, it is also of interest that tumor growth and diabetic retinopathy are associated with pathological signaling of flk-1 characterized by hyperpermeable neovascularization as it is seen in CSH [85]. Hara M, Tamaki M, Aoyagi M, Ohno K. Possible role of cyclooxygenase-2 in developing chronic subdural hematoma. Sun TF, Boet R, Poon WS. The role of neither one has yet been elucidated in CSH. Kao MC. 7.6 Chronisches subdurales Hämatom (cSDH) 7.6.1 Definition. Vascular endothelial growth factor receptor-2: structure, function, intracellular signalling and therapeutic inhibition. The role of eosinophils in pulmonary fibrosis (Review). Die Ursache ist in der Regel eine Blutung aus einer Vene nach einer Kopfverletzung. It is characterized by an elevated inflammatory response after trauma associated with increased levels of IL-6 [196]. Neuroinflammation and the genetics of Alzheimer’s disease: the search for a pro-inflammatory phenotype. Nurmi L, Heikkilä HM, Vapaatalo H, Kovanen PT, Lindstedt KA. I. Kalamatianos T, Stavrinou LC, Koutsarnakis C, Psachoulia C, Sakas DE, Stranjalis G. PlGF and sVEGFR-1 in chronic subdural hematoma: implications for hematoma development. Platelet-activating factor (PAF) and the development of chronic subdural haematoma. Total and differential white blood cell counts and their associations with circulating interleukin-6 levels in community-dwelling older women. When quiescent vessels sense an angiogenic stimulus like VEGF, bFGF, or ANG 2, pericytes liberate from the shared basement membrane by proteolytic degradation. Dura mater und Arachnoidea , die unterschiedlich schwer verlaufen kann (von nahezu unbemerkt über mehrere Wochen bis hin zu rascher Progredienz innerhalb weniger Stunden). Furthermore, estrogen has a vasoprotective effect in women [168]. Fischer C, Mazzone M, Jonckx B, Carmeliet P. FLT1 and its ligands VEGFB and PlGF: drug targets for anti-angiogenic therapy? Gill M, Maheshwari V, Narang A, Lingaraju TS. Rudiger A, Ronsdorf A, Merlo A, Zimmerli W. Dexamethasone treatment of a patient with large bilateral chronic subdural haematomata. Measurement of inflammatory cytokines and thrombomodulin in chronic subdural hematoma. The role of angiotensin-converting enzyme inhibitors in patients with chronic subdural hematoma: a scandinavian population-based multicenter study. Chronic subdural haematoma is a collection of liquid (as opposed to solid or clotted) blood between the brain and the lining of the brain (the dura). Sherrod BA, Baker C, Gamboa N, McNally S, Grandhi R. Preoperative MRI characteristics predict chronic subdural haematoma postoperative recurrence: a meta-analysis. Symptome Diagnose Behandlung Intrazerebrale Hämatome Intrakranielle Hämatome (Hirnblutungen) sind Ansammlungen von Blut im Innern des Schädels, entweder innerhalb des Gehirns oder zwischen Gehirn und Schädeldecke. 2016;6(4). Overall, it is feasible that there is a positive net effect of estrogen in patients at risk for the development of CSH. Downregulation of Bradykinin type 2 receptor expression in cardiac endothelial cells during senescence. II. Yamashima T, Yamamoto S. How do vessels proliferate in the capsule of a chronic subdural hematoma? Hayek MG, Mura C, Wu D, Beharka AA, Han SN, Paulson KE, et al. Stanisic M, Aasen AO, Pripp AH, Lindegaard KF, Ramm-Pettersen J, Lyngstadaas SP, et al. Recently, a similar preponderance of ANG2 was verified at the protein level within the hematoma [98]. Rempe RG, Hartz AMS, Bauer B. Matrix metalloproteinases in the brain and blood-brain barrier: versatile breakers and makers. As a library, NLM provides access to scientific literature. There is evidence that treatment with etizolam reduces the risk of recurrence [129], and it is negatively correlated with the need for surgery [130]. Einschränkung von Orientierung und Konzentrationsfähigkeit. Activation of JAK-STAT3 signaling pathway in chronic subdural hematoma outer membranes. Bei einem chronischen subduralen Hämatom sickert das Blut dagegen nur langsam ein. Auch das Subduralhämatom entsteht in der Regel im Rahmen eines Unfalls, es sind jedoch auch spontane Blutungen möglich. Eine chronische SDH führt nicht immer zu Symptomen. Die Symptome entwickeln sich meist schleichend und können mitunter erst Wochen nach der Kopfverletzung in Erscheinung treten. Definition Ein subdurales Hämatom (SDH, subdurale Blutung) ist eine Blutung, die normalerweise durch ein Kopftrauma verursacht wird, in den Raum zwischen den duralen und arachnoidalen Meningealschichten, die das Gehirn umgeben, wodurch ein Raum entsteht, der als subduraler Raum bezeichnet wird. However, compared to serum, the concentration of PDGF is reduced within the hematoma [2]. Marcumar!) Ito H, Yamamoto S, Saito K, Ikeda K, Hisada K. Quantitative estimation of hemorrhage in chronic subdural hematoma using the 51Cr erythrocyte labeling method. Introduction and results of a survey by the French Society of Neurosurgery. Tumorigenesis and the angiogenic switch. Age probably has an impact on all of these eventualities. Hirashima Y, Endo S, Kato R, Ohmori T, Nagahori T, Nishijima M, et al. The pathogenesis and clinical significance of traumatic subdural hygroma. Ito H, Shimoji T, Yamamoto S, Saito K, Uehara S. Colloidal osmotic pressure in chronic subdural hematoma. Leng S, Xue QL, Huang Y, Semba R, Chaves P, Bandeen-Roche K, et al. Also, the ANG1/ANG2 ratio was shown to be indicative of ongoing angiogenesis [90]. Zu den Anzeichen und Symptomen zählen Kopfschmerzen, Schwäche, Sprechstörungen sowie Ausfallerscheinungen beim Sprachvermögen, Übelkeit, Erbrechen, Krampfanfälle und Bewusstlosigkeit; manchmal verstirbt der Betroffene. Suzuki K, Takano S, Nose T, Doi M, Ohashi N. Increased concentration of vascular endothelial growth factor (VEGF) in chronic subdural hematoma [letter]. Doncaster East VIC 3109, Victoria: +61 3 8862 0000 Long-term excess mortality after chronic subdural hematoma. Throughout the neomembranes, it is constantly expressed in conjunction with VEGF and it has been suggested that HIF is one of the main inducers of VEGF expression in CSH [101]. Aging and angiogenesis. Links: Das Subduralhämatom liegt zwischen Arachnoidea und Dura mater und stellt sich sichelförmig dar. Bartek J, Jr, Sjåvik K, Schaible S, Gulati S, Solheim O, Förander P, et al. Br J Neurosurg. Furthermore, pathological vascularization of the outer membrane was studied in more detail [85, 150, 151], and exsudation was identified as an important mechanism of hematoma enlargement [7, 152]. Frequency of conservatively managed traumatic acute subdural haematoma changing into chronic subdural haematoma. Marked tissue eosinophilia within organizing chronic subdural hematoma membranes. Nakamura S, Tsubokawa T. Extraction of angiogenesis factor from chronic subdural haematomas. Moreover, Hua and colleagues correlated the concentration of VEGF and matrix metalloproteinase (MMP) 2 and 9 [53] which are important proangiogenic factors that trigger an angiogenic switch in an otherwise quiescent vascular bed [54, 55]. Additionally, proteases like MMPs liberate angiogenic molecules stored in the provisional extracellular matrix (ECM). The physical background of MRI is much more complex and the prediction of resolution of the CSH or its recurrence is much more challenging [43]. Moreover, the age profile of CSH patients strongly points to age-dependent alterations of the involved physiological immune responses and angiogenic pathways which may involve genomic instability, epigenetic defects, dysregulation of metabolic pathways, increased cell senescence, impaired cell regeneration, increased reactive oxygen species by mitochondria, and loss of proteostasis [36]. In general, a prolonged inflammatory response delays wound healing and probably promotes tissue fibrosis reducing the chance of true regeneration [159, 160]. : Elsevier Saunders; 2011. p. 535–43. Obviously, there are mechanisms involved in CSH that can cause different chronological scenarios paralleling encapsulation of the hematoma, rebleeding, and exsudation [38]. Carmeliet P, Jain RK. The latter indicate that immunological and angiogenic mechanisms are pivotal for CSH development and enlargement which is fundamentally different from the pathophysiology of acute subdural hematoma [2–9]. Subdurales und epidurales Hämatom in der CCT. Anhand die- Die Symptome bei einem chronischen Subduralhämatom entwickeln sich oft langsam und präsentieren sich häufig mit geringen Symptomen wie Kopfschmerzen, Verwirrung oder Sprachstörungen 2. Another issue to consider is that in the elderly the number of peripheral eosinophils correlates with elevated serum levels of IL-6 [199]. Mannheim: Ruprecht Karls Universität Heidelberg, Fakultät für klinische Medizin Mannheim; 2003. p. 91. The sequential steps of vessel branching are well orchestrated by various types of biological factors which are also active in CSH development. Chronic Subdural Hematoma (Haemorrhage) Chronic subdural haematoma is a collection of liquid (as opposed to solid or clotted) blood between the brain and the lining of the brain (the dura). 10.3109/02688697.2014.918578. VEGF increases endothelial permeability by separate signaling pathways involving ERK-1/2 and nitric oxide. Chronic subdural hematoma (CSH) affects mostly the elderly with increasing relevance due to aging of the population both in Western and Asian countries [].Apart from the mechanistic view that CSH is simply a posttraumatic subdural collection of blood and its degradation products becoming symptomatic because of its space-occupying effect, new insights including molecular . Holl DC, Volovici V, Dirven CMF, Peul WC, van Kooten F, Jellema K, et al. Neben einer akuten Form mit Bewusstseinsverlust gibt es eine chronische Form, deren Symptome sich über Wochen entwickeln können. Here, we critically review novel pathophysiological, imaging, interventional, and medical treatment aspects and establish an integrative concept of the pathogenesis of CSH stressing the role of age as key factor. Gharaee-Kermani M, Phan SH. A recent metanalysis on the importance of low signal intensity in T1-weighted images seems to confirm an increased recurrence rate in these cases [52]. Patients with chronic subdural haematoma can experience a variety of non-specific symptoms, including headache, speech disturbance, or confusion. It has been shown that aging impacts virtually every angiogenic pathway identified thus far [169, 170]. Ein Subduralhämatom ist eine Blutansammlung, die zwischen zwei Hirnhäuten auftritt und meist durch eine Kopfverletzung oder einen Sturz verursacht wird. In contrast to COX-1, it is synthesized on demand in cases of injury, inflammation, or cell proliferation, and it is involved in the induction of angiogenesis [204]. Because of its broad availability, the short acquisition time, and its relative insusceptibility for movement artifacts in potentially noncompliant patients, CT-based imaging is still the primary method of choice [37]. Spinale Epiduralhämatome im Bereich des Rückenmarks . Glover D, Labadie EL. Dexamethason verschlechtert den klinischen Outcome. Expression of mitogen-activated protein kinases in chronic subdural hematoma outer membranes. It was shown to be stable in a mouse model for aging of skeletal muscles whereas the TIE receptor mRNA was decreased [206]. Wolf J, Weinberger B, Arnold CR, Maier AB, Westendorp RG, Grubeck-Loebenstein B. The outer ring represents different biological processes that are involved: angiogenesis, coagulation, and inflammation. Saito K, Ito H, Hasegawa T, Yamamoto S. Plasmin-alpha 2-plasmin inhibitor complex and alpha 2-plasmin inhibitor in chronic subdural hematoma. Wagatsuma A. Suzuki M, Endo S, Inada K, Kudo A, Kitakami A, Kuroda K, et al. Consecutively, they concluded that high intense hematomas reflect the lowest risk for rebleeding. Tumor necrosis factor-alpha inhibits transforming growth factor-beta-stimulated myofibroblastic differentiation and extracellular matrix production in human gingival fibroblasts. durch Bagatelltraumata ausgelöst wird. Targeted disruption of TGF-beta1/Smad3 signaling protects against renal tubulointerstitial fibrosis induced by unilateral ureteral obstruction. Weigel R, Hohenstein A, Schlickum L, Weiss C, Schilling L. Angiotensin converting enzyme inhibition for arterial hypertension reduces the risk of recurrence in patients with chronic subdural hematoma possibly by an antiangiogenic mechanism. While the presence of some of these mechanisms per se indicates a pathological condition, it remains unclear whether or not some findings are truly pathological or they simply represent a physiological process. Additionally, the layering type had a higher fibrinolytic activity. Ha VT, Nguyen TN, Nguyen TX, Nguyen HTT, Nguyen TTH, Nguyen AT, et al. Son S, Yoo CJ, Lee SG, Kim EY, Park CW, Kim WK. A similar correlation was found also on the basis of a MRI classification [46]. Miranda LB, Braxton E, Hobbs J, Quigley MR. High levels of VEGF and PlGF and overexpression of ANG-2 within the neomembranes keep newly sprouted vessels leaky by activation of the MEK/ERK signal transducers. Inflammation is part of the wound healing process that induces further steps such as new tissue formation and tissue remodeling. A Few hours after a bicycle accident without loss of consciousness. The concentrations of proangiogenic and proinflammatory cytokines and chemokines are elevated. Soleman J, Nocera F, Mariani L. The conservative and pharmacological management of chronic subdural haematoma. R.W. Nauck M, Karakiulakis G, Perruchoud AP, Papakonstantinou E, Roth M. Corticosteroids inhibit the expression of the vascular endothelial growth factor gene in human vascular smooth muscle cells. Merchan JR, Chan B, Kale S, Schnipper LE, Sukhatme VP. Nyberg L, Boraxbekk CJ, Sörman DE, Hansson P, Herlitz A, Kauppi K, et al. Esophageal remodeling in pediatric eosinophilic esophagitis. Ashcroft GS, Horan MA, Ferguson MW. Nomura S, Kashiwagi S, Ito H, Mimura Y, Nakamura K. Degradation of fibrinogen and fibrin by plasmin and nonplasmin proteases in the chronic subdural hematoma: evaluation by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblot. When expression of the receptor TIE is reduced in aging vascular structures, a relative preponderance of the ANG2 signal will result and the vascular integrity will be reduced [206]. [123]). Über 50 bis 90 Prozent von Menschen, die akute subdurale Hämatome entwickeln, sterben an der Krankheit oder ihren Komplikationen. Trial of dexamethasone for chronic subdural hematoma. Steroids inhibit IL-6 and IL-8 and reduce the expression of VEGF [108–111]. Nakagawa T, Kodera T, Kubota T. Expression of matrix metalloproteinases in the chronic subdural haematoma membrane. Lee KS. Ein subdurales Hämatom tritt auf, wenn Eine Vene reißt zwischen Ihrem Schädel und der Oberfläche Ihres Gehirns. Significance in capsule formation and haematoma growth. Aging up-regulates expression of inflammatory mediators in mouse adipose tissue. In a small size retrospective analysis, atorvastatin given as an adjunct to surgery reduced significantly the rate of postoperative recurrence [134]. used a classification that differentiated 5 types of CSH: hyperdense, isodense, hypodense, mixed, and layering type. Expression of angiopoietins and angiogenic signaling pathway molecules in chronic subdural hematomas. More recently, Osuka et al. These are the tiny veins that run between the dura and surface of the brain. It seems that the appearance of hematoma fluid is mainly a function of hemoglobin and its degradation products. Chronisch subdurales Hämatom bei einem Patienten mit Verdacht auf Prodromalstadium einer Schizophrenie Zusammenfassung Bei einem Patienten, der mit psychoseverdäch-tigen „Prodromal-Symptomen" der Früherken-nungssprechstunde für Psychosen zugewiesen wurde, konnte mittels MRI ein chronisch subdu-rales Hämatom festgestellt werden. The exact mechanism of the correlation has not yet been elucidated; however, a similar constellation is present within the neomembranes and the hematoma fluid of CSH patients [63, 64, 66, 200]. Ito and colleagues had demonstrated in the 1980s that high and mixed density hematomas represent recent rebleeding [39] whereas Kao showed that hematomas of the layering type have a high tendency to rebleed [40].