Chronic Subdural Hematoma Preceded by High-Impact Trauma: Does the Intensity of Trauma Influence the Pathogenesis of Traumatic Chronic Subdural Hematoma?
OBJECTIVE
The purpose of this study was to investigate whether the intensity of trauma influences the pathogenesis of traumatic chronic subdural hematoma (CSDH).


METHODS
Thirty-one patients treated surgically for traumatic CSDH were divided into high-impact and lowimpact groups according to the intensity of trauma. They were respectively evaluated with respect to clinical and radiological findings at presentation, and the subdural concentrations of interleukin-6 (IL-6), interleukin-8 (IL-8), vascular endothelial growth factor (VEGF), basic fibroblast growth factor, and beta-trace protein (&Beta;TP) [a highly specific protein in the cerebrospinal fluid (CSF)] related to the pathogenesis of CSDH. If &Beta;TP (subdural fluid/serum) was > 2, an admixture of CSF to the subdural fluid was indicated.


RESULTS
The &Beta;TP (subdural fluid/serum) was > 2 in all patients with a traumatic CSDH. The mean concentration of subdural &Beta;TP in the high-impact group was higher than in the low-impact group (6.1 mg/L versus 3.9 mg/L), and the difference was statistically significant (p=0.02). In addition, mean concentrations of IL-6, IL-8 and VEGF were higher in the high-impact group, as compared to the low-impact group, though the differences did not reach statistical significance.


CONCLUSIONS
Trauma may be related to CSF leakage into the subdural space in CSDH, and the intensity of trauma may influence the amount of CSF leakage. Although there is no direct correlation between the amount of CSF leakage and other subdural molecules, the intensity of trauma may be associated with larger concentrations of molecules in traumatic CSDH.
Kyungpook National University School of Medicine, Department of Neurosurgery, Daegu, Republic of Korea.
Ki-Su
KS
Park
Chang-Heon
CH
Lee
Seong-Hyun
SH
Park
Sung-Kyoo
SK
Hwang
Jeong-Hyun
JH
Hwang
D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000134:cerebrospinal fluid / Q000150:complications* / Q000473:pathology*; D065634:Cerebrospinal Fluid Leak / Q000150:complications; D005260:Female; D016222:Fibroblast Growth Factor 2 / Q000134:cerebrospinal fluid; D020200:Hematoma, Subdural, Chronic / Q000134:cerebrospinal fluid / Q000150:complications* / Q000473:pathology*; D006801:Humans; D015850:Interleukin-6 / Q000134:cerebrospinal fluid; D016209:Interleukin-8 / Q000134:cerebrospinal fluid; D019746:Intramolecular Oxidoreductases / Q000134:cerebrospinal fluid; D054834:Lipocalins / Q000134:cerebrospinal fluid; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D042461:Vascular Endothelial Growth Factor A / Q000134:cerebrospinal fluid
C508606:CXCL8 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6; D016209:Interleukin-8; D054834:Lipocalins; D042461:Vascular Endothelial Growth Factor A; D016222:Fibroblast Growth Factor 2; D019746:Intramolecular Oxidoreductases; C022466:prostaglandin R2 D-isomerase