Chronic Subdural Hematoma Preceded by High-Impact Trauma: Does the Intensity of Trauma Influence the Pathogenesis of Traumatic Chronic Subdural Hematoma?
AIM: The purpose of this study was to investigate whether the intensity of trauma influences the pathogenesis of traumatic chronic
subdural hematoma (CSDH).
MATERIAL and 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 (ΒTP) [a highly specific protein in the cerebrospinal fluid (CSF)]
related to the pathogenesis of CSDH. If ΒTP (subdural fluid/serum) was >2, an admixture of CSF to the subdural fluid was indicated.
RESULTS: The ΒTP (subdural fluid/serum) was >2 in all patients with a traumatic CSDH. The mean concentration of subdural ΒTP
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.
CONCLUSION: 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.