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Cerebral perfusion changes in chronic subdural hematoma

Philipp Jörg Slotty1, Marcel Alexander Kamp, Steiger Hans-Jakob Steiger

  • 1Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany. slotty@med.uni-duesseldorf.de

Journal of Neurotrauma
|December 12, 2012
PubMed

Insights

Chronic subdural hematoma (cSDH) in elderly patients may cause neurological symptoms due to impaired brain perfusion. This study found intact cerebral autoregulation in cSDH, with upregulated blood flow and volume below the hematoma, suggesting borderline perfusion causes deficits.

Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Chronic subdural hematoma (cSDH) is common in the elderly, but the cause of its clinical symptoms remains unclear.
  • Perfusion deficits are suspected to cause transient neurological symptoms in cSDH patients.

Purpose of the Study:

  • To quantify cerebral perfusion impairment in patients with chronic subdural hematoma (cSDH).
  • To correlate clinical and radiological data in cSDH patients.

Main Methods:

  • Neurological examination using the National Institutes of Health Stroke Scale (NIHSS) score in 34 patients before surgery.
  • CT perfusion imaging to assess cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and Tmax.
  • Recording of hematoma volume, localization, and configuration.

Main Results:

  • Mean hematoma volume was 91.8 cm³ (SD 49.5).
  • Whole brain mean transit time (MTT) was slightly elevated (mean 36.6 sec, SD 5.8).
  • Cerebral blood flow (CBF) and cerebral blood volume (CBV) were significantly upregulated in the area below the hematoma (ABH) compared to the contralateral cortex (MAC) (p<0.01).
  • MTT and Tmax showed no significant difference between the ABH and MAC.

Conclusions:

  • Cerebral autoregulation is active and intact in the cortical area below cSDH.
  • Upregulated CBF and CBV in the ABH indicate autoregulation in tissue at risk of ischemia.
  • Neurological deficits in cSDH are likely caused by borderline brain perfusion.

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