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2017 ; 14
(1
): 108
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gab.com Text
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English Wikipedia
Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and
implications for pharmacotherapy
#MMPMID28558815
Edlmann E
; Giorgi-Coll S
; Whitfield PC
; Carpenter KLH
; Hutchinson PJ
J Neuroinflammation
2017[May]; 14
(1
): 108
PMID28558815
show ga
Chronic subdural haematoma (CSDH) is an encapsulated collection of blood and
fluid on the surface of the brain. Historically considered a result of head
trauma, recent evidence suggests there are more complex processes involved.
Trauma may be absent or very minor and does not explain the progressive, chronic
course of the condition. This review focuses on several key processes involved in
CSDH development: angiogenesis, fibrinolysis and inflammation. The characteristic
membrane surrounding the CSDH has been identified as a source of fluid exudation
and haemorrhage. Angiogenic stimuli lead to the creation of fragile blood vessels
within membrane walls, whilst fibrinolytic processes prevent clot formation
resulting in continued haemorrhage. An abundance of inflammatory cells and
markers have been identified within the membranes and subdural fluid and are
likely to contribute to propagating an inflammatory response which stimulates
ongoing membrane growth and fluid accumulation. Currently, the mainstay of
treatment for CSDH is surgical drainage, which has associated risks of recurrence
requiring repeat surgery. Understanding of the underlying pathophysiological
processes has been applied to developing potential drug treatments. Ongoing
research is needed to identify if these therapies are successful in controlling
the inflammatory and angiogenic disease processes leading to control and
resolution of CSDH.