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Recurrence of chronic subdural hematoma due to low-grade infection

Daniel Dubinski1, Sae-Yeon Won1, Svorad Trnovec1

  • 1Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany.

Frontiers in Neurology
|October 10, 2022
PubMed

Insights

Clinically inapparent, low-grade hematoma infections may drive chronic subdural hematoma (CSDH) recurrence. Staphylococcus species were frequently identified, suggesting a novel pathophysiology for CSDH.

Area of Science:

  • Neurosurgery
  • Infectious Diseases
  • Pathophysiology

Background:

  • Chronic subdural hematoma (CSDH) recurrence presents a significant clinical challenge.
  • Existing risk factors and pathophysiology for CSDH recurrence remain debated.
  • A potential role for subclinical infection in CSDH recurrence is hypothesized.

Purpose of the Study:

  • To investigate the hypothesis that clinically inapparent, low-grade infections contribute to CSDH recurrence.
  • To identify the microbiological agents involved in recurrent CSDH cases.

Main Methods:

  • A single-center prospective observational study was conducted.
  • 44 patients with recurrent CSDH underwent intraoperative swab-based microbiological testing.
  • Infection rates and common microbial genera were analyzed.

Main Results:

  • An inapparent low-grade hematoma infection was detected in 29% of recurrent CSDH cases.
  • Staphylococcus species accounted for the majority (69%) of identified microorganisms.
  • This suggests a potential infectious etiology in a significant subset of recurrent CSDH.

Conclusions:

  • Low-grade, clinically inapparent infections may represent a novel pathophysiology for CSDH recurrence.
  • Staphylococcus is a predominant pathogen in these infectious cases.
  • Further research is warranted to explore the clinical implications and management strategies for infectious CSDH recurrence.
Keywords:
MMA occlusionchronic subdural hematomadexamethasoneinfected subdural hematoma recurrencerecurrence

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