Chronic subdural hematoma (CSDH) is a common neurosurgical pathology, yet conflicting opinions exist concerning the pathophysiological processes involved. Many consider CSDH a product of an aged acute subdural hematoma (ASDH) secondary to trauma. Serial imaging, however, has demonstrated CSDH formation in patients without any initial ASDH. To understand the relevance of acute hemorrhage in a cohort of patients with CSDH, transformation from an ASDH were categorized as CSDH-acute transformed (CSDH-AT) and those without any acute hemorrhage at the outset as CSDH-de-novo (CSDH-DN). A cohort of 41 eligible patients with CSDH were included, with baseline imaging after trauma (or spontaneous ASDH) available for assessment of acute hemorrhage. Volumetric analysis of all subdural collections and measurements of baseline atrophy were performed. In 37% of cases, there was an ASDH present on baseline imaging (CSDH-AT), whereas 63% had no acute hemorrhage at baseline (CSDH-DN). The CSDH-ATs developed more rapidly (mean 16 days from baseline to diagnosis) and were smaller in volume than the CSDH-DNs, which developed at a mean delay of 57 days. In 54% of the CSDH-DNs, a subdural hygroma was present on baseline imaging, and there was a wide range of baseline cerebral atrophy. This study provides radiological evidence for two distinct pathways in the formation of CSDH, with CSDH-DN occurring more commonly and often involving subdural hygroma. Further work is needed to understand whether the pathological origin has implications for patient outcome.

中文翻译：

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慢性硬膜下血肿的发病机制：一组证据证明新发和转化起源


慢性硬膜下血肿（CSDH）是一种常见的神经外科病理学，但关于所涉及的病理生理过程存在相互矛盾的观点。许多人认为 CSDH 是继发于创伤的老年急性硬膜下血肿 (ASDH) 的产物。然而，系列成像显示，在最初没有任何 ASDH 的患者中，CSDH 形成。为了了解 CSDH 患者队列中急性出血的相关性，将 ASDH 转化为 CSDH-急性转化 (CSDH-AT)，将一开始没有任何急性出血的转化为 CSDH-从头(CSDH-DN) ）。纳入了 41 名符合条件的 CSDH 患者队列，创伤后（或自发性 ASDH）基线成像可用于评估急性出血。对所有硬膜下收集物进行体积分析并测量基线萎缩。 37% 的病例在基线影像学上存在 ASDH (CSDH-AT)，而 63% 的病例在基线时没有急性出血 (CSDH-DN)。 CSDH-AT 比 CSDH-DN 发育更快（从基线到诊断平均需要 16 天），体积更小，CSDH-DN 发育平均延迟 57 天。在 54% 的 CSDH-DN 中，基线成像存在硬膜下积液，并且存在大范围的基线脑萎缩。这项研究为 CSDH 形成的两种不同途径提供了放射学证据，其中 CSDH-DN 发生更常见，并且经常涉及硬膜下积液。需要进一步的工作来了解病理起源是否对患者的治疗结果有影响。