Chronic subdural haematoma (CSDH) is invariably classified as 'neurotrauma'. However, whilst a history of trauma/fall is frequent, it is usually distant, mild or even absent. Serum S-100β > 1.38 μg/L is associated with a 100% specificity for mortality/poor outcome acutely after moderate-severe neurotrauma. Serum S-100β > 0.10 μg/L is used to screen mild neurotrauma cases for emergent neuro-imaging. Serum S-100 in controls is 0.057 μg/L. S-100β in serum or CSDH fluid (CSDH) has not been studied. No normal 'subdural fluid' exists to compare CSDH. We measured serum and CSDH S-100β at surgical drainage in a novel prospective single-centre cohort. Of n = 86/86 (100%, M65, age 73 ± 13yrs), n = 66 (76%) reported mild trauma/fall 31 ± 23 days previously. N = 54 (63%) presented with good clinical Markwalder Grade (MG: 0-1). Paired serum and CSDH S-100β samples were obtained in n = 45. CSDH S-100β (n = 80) was elevated (0.9 ± 0.6 μg/L), was significantly higher than serum S-100β (n = 51) (0.33 ± 0.05 μg/L, P = 0.002), and was significantly correlated with midline-shift (r = 0.43, P = 0.005) and CSDH volume (r = 0.225, P = 0.046). CSDH S-100β was not significantly associated with any demographic factor, co-morbidity or outcome measure. CONCLUSIONS: Despite expectations, S-100β was elevated in serum CSDH, but was significantly higher in CSDH. Indeed, CSDH S-100β approached serum levels associated with a poor prognosis after acute-neurotrauma. However, CSDH S-100β did not represent a biomarker for trauma nor functional outcome. Whilst the non-traumatic source for on-going S-100β release could not be determined, prolonged compression of an atrophic brain, subsequent CSF leakage, or 'subdural-space' meningeal disruption/proliferation, represent theoretical possibilities. Elevated S-100β may therefore not be specific for mild-moderate-severe acute neurotrauma. Alternative non-traumatic intra-cranial mechanisms evidently also exist.
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http://dx.doi.org/10.1016/j.jocn.2019.05.058 | DOI Listing |
Cureus
December 2024
Neurosurgery, St. Marianna University School of Medicine, Kawasaki, JPN.
Over-drainage after a ventriculoperitoneal (VP) shunt can often lead to chronic subdural hematoma; however, the treatment is unclear. Hematoma drainage is performed after physically stopping the shunt function, such as by ligating or removing the shunt system. However, shunt reconstruction is required after the subdural hematoma improves.
View Article and Find Full Text PDFNeurosurgery
January 2025
Department of Neurosurgery, Komaki City Hospital, Komaki, Aichi, Japan.
Background And Objectives: Transient neurological deficits (TNDs) in patients with chronic subdural hematoma (CSDH), such as fluctuating aphasia, hemiparesis, or sensory disturbances, present diagnostic and treatment challenges as their pathophysiology remains unclear. The aim of this study was to investigate the association between specific MRI findings and TNDs in patients with CSDH and explored their relationship through intraoperative observation.
Methods: We retrospectively evaluated 72 patients with CSDH who underwent preoperative MRI among 251 CSDH patients treated from January 2020 to December 2023.
Neurosurgery
January 2025
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
Background And Objectives: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. However, current evidence on postoperative outcomes exhibits variability due to small sample sizes, nonstandardized outcome assessment, and variations in surgical techniques. The aim of this study was to overcome these limitations by assessing standardized outcome measures after surgical intervention for CSDH at a high-volume population-based center favoring a uniform burr-hole craniotomy (BHC) approach.
View Article and Find Full Text PDFJ Neurol Surg A Cent Eur Neurosurg
December 2024
Division of Neurosurgery, University of Rome Tor Vergata, Rome, Italy.
Background: Chronic subdural hematoma (cSDH) is a common pathology in daily practice of neurosurgery. Surgical management usually offers a significant clinical recovery. However, the recurrence rate is still high.
View Article and Find Full Text PDFLangenbecks Arch Surg
December 2024
Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Lyari Hospital Rd, Rangiwara Karachi, Karachi City, Sindh, 75010, Pakistan.
To the Editor,I would like to acknowledge the valuable efforts taken to enhance the knowledge through the article "Prediction model for poor short-term prognosis in patients with chronic subdural hematoma (CSDH) after burr hole drainage: a retrospective cohort study" [1]. We thoroughly read this article published in your journal and learned the aim behind this study. This article has described every aspect of determining prognosis postoperatively in patients after evacuation of chronic subdural hematoma via a single burr hole.
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