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Review
. 2017 Dec:108:954-958.
doi: 10.1016/j.wneu.2017.09.063. Epub 2017 Sep 19.

Chronic Subdural Hematoma: A Perspective on Subdural Membranes and Dementia

Ronald Sahyouni  1 , Khodayar Goshtasbi  2 , Amin Mahmoodi  3 , Diem Kieu Tran  3 , Jefferson W Chen  4
Affiliations
Review

Chronic Subdural Hematoma: A Perspective on Subdural Membranes and Dementia

Ronald Sahyouni et al. World Neurosurg. 2017 Dec.

Abstract

Objective: To review the complex pathogenesis of the subdural membrane and the link between head trauma, dementia, and dural lymphatics.

Methods: A thorough literature search of published English-language articles was performed using PubMed, Ovid, and Cochrane databases.

Results: Chronic subdural hematoma (cSDH) is a common intracranial pathology and a leading cause of reversible dementia. cSDH is projected to affect at least 60,000 new individuals in the United States annually by 2030. This condition can result from mild to moderate head trauma that leads to hemorrhaging in the dura-arachnoid interface. The short-term and long-term effects of cSDH and the subdural membrane on the pathogenesis of dementia and the newly discovered dural lymphatics is a topic of increasing importance.

Conclusions: Further research into the possible link between traumatic brain injury and cSDH in particular and dural lymphatics and intracranial fluid dynamics is warranted.

Keywords: Chronic; Dementia; Hematoma; Lymphatics; Membrane; Neurosurgery; Subdural; Trauma.

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Conflict of interest statement

Financial interests: None

Disclosure

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

Figure 1
Figure 1
Diagram illustrating a chronic subdural hematoma (cSDH) between the dura-arachnoid interface (coronal view) and the associated inner/outer membranes.
Figure 2
Figure 2
Histological classifications of the outer chronic subdural hematoma membrane depicting A) a Type I noninflammatory membrane which contains immature fibroblasts and collagen fibers. B) Type II inflammatory membrane consisting of a single layer of immature connective tissue and associated with marked vascularization and cell infiltration. C) Type III hemorrhagic inflammatory membrane which consists of 2–3 layers associated with large diameter capillaries and marked cell infiltration with proliferation of new vessels accompanied by hemorrhage into the membrane. D) Type IV scar inflammatory membrane depicting inflammatory cell infiltration, hemorrhage, and neovascularization. Adapted, with copyright clearance, from Nagahori et al., 1993.
See this image and copyright information in PMC

References

    1. Fogelholm R, Waltimo O. Epidemiology of chronic subdural haematoma. Acta neurochirurgica. 1975;32(3):247–50. - PubMed
    1. Markwalder T-M. Chronic subdural hematomas: a review. Journal of neurosurgery. 1981;54(5):637–45. - PubMed
    1. Asghar M, Adhiyaman V, Greenway M, Bhowmick BK, Bates A. Chronic subdural haematoma in the elderly—a North Wales experience. Journal of the royal society of medicine. 2002;95(6):290–2. - PMC - PubMed
    1. Miranda LB, Braxton E, Hobbs J, Quigley MR. Chronic subdural hematoma in the elderly: not a benign disease: clinical article. Journal of neurosurgery. 2011;114(1):72–6. - PubMed
    1. Baechli H, Nordmann A, Bucher H, Gratzl O. Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single-center cohort study. Neurosurgical review. 2004;27(4):263–6. - PubMed

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