What is the role of brain biochemical patterns in the pathogenesis of acute subdural hematoma (SDH)?

Updated: Jul 26, 2018
  • Author: Richard J Meagher, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Investigation of brain physiological and biochemical parameters in patients with acute traumatic subdural hematoma has suggested variables that might be associated with secondary injury to the brain.

In a study of brain biochemical patterns after acute subdural hematoma evacuation, Hlatky et al found that postsurgical patients who succumbed to their injury exhibited lower values of brain tissue oxygen tension and higher dialysate values of lactate and pyruvate in the brain underlying the hematoma. They suggested that identification of this brain biochemistry pattern after surgery might signify an evolving brain injury that warrants further evaluation or treatment. [5]

Cerebral blood flow (CBF) can become markedly reduced. Schroder et al reported that in 2 patients with acute subdural hematoma requiring emergent craniotomy, the hemisphere ipsilateral to the subdural hematoma demonstrated lower CBF than the contralateral hemisphere. Furthermore, CBF in both hemispheres was lower than normal. [6]

Impressive increases in CBF and cerebral blood volume (CBV) that could not be attributed to pCO2 or blood pressure changes were noted immediately after surgery. The authors speculated that the decreased CBV caused by the subdural hematoma was a result of a compressed microcirculation, which was caused by increased ICP. [6]

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