New pathomorphological classification of subdural hematomas

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Abstract

Objective – to develop a pathomorphological classification of subdural hematomas, which reflects the aspects of their pathogenesis and time of occurrence that are important for forensic analysis.

Materials and methods. The study is based on a prospective pathomorphological analysis of the qualitative evolution of 200 of subdural hematomas in closed and open non-penetrating craniocerebral trauma.

Results. The new pathomorphological classification of subdural hematomas is developed. It takes into account a hierarchical sequence of hematoma characteristics: the presence and severity of organization; the genesis of encapsulation and resorption, and the mechanism of organization.

Conclusion. The developed pathomorphological classification is recommended for use in the course of forensic or medical expert analysis of subdural hematomas.

About the authors

German V. Nedugov

Samara State Medical University

Author for correspondence.
Email: nedugovh@mail.ru
ORCID iD: 0000-0002-7380-3766

PhD, assistant of the Department of forensic medicine

Russian Federation, Samara

Tatyana A. Fedorina

Samara State Medical University

Email: nedugovh@mail.ru
ORCID iD: 0000-0003-1313-1838

PhD, Professor, Head of the Department of general and clinical pathology: pathological anatomy, pathological physiology

Russian Federation, Samara

References

  1. Nedugov GV. Subduralnye gematomy. Samara: Ofort; 2011. (In Russ.). [Недугов Г.В. Субдуральные гематомы. Самара: Офорт, 2011].
  2. Alves JL, Santiago JG, Costa G, Mota Pinto A. A Standardized Classification for Subdural Hematomas-I. Am J Forensic Med Pathol. 2016;37(3):174–178. doi: 10.1097/PAF.0000000000000255 PubMed PMID: 27428027
  3. Wintzen AR. The clinical course of subdural haematoma. A retrospective study of aetiological, chronological and pathological features in 212 patients and a proposed classification. Brain. 1980;103(4):855–867. PubMed PMID: 7437892
  4. Borowska-Solonynko A, Krajewski P, Koktysz R, Koperski Ł. Wybrane cechy budowy mikroskopowej jako element dodatkowy w ocenie wieku krwiaków podtwardowkowych. Arch Med Sadowej Kryminol. 2010;60(2–3):96–101.
  5. Nakaguchi H, Teraoka A, Suzuki Y, Adachi S. Relationship between classification of CSDH according to the Internal architecture and hematoma contents. No Shinkei Geka. 2003;31(6):639–646. (In Japan.). PubMed PMID: 12833873
  6. Gandhoke GS, Kaif M, Choi L, et al. Histopathological features of the outer membrane of chronic subdural hematoma and correlation with clinical and radiological features. J Clin Neurosci. 2013;20(10):1398–1401. doi: 10.1016/j.jocn.2013.01.010 PMID: 23916760
  7. Pigolkin YuI, Kasumova SV, Romanov AN. The morphological characteristics of chronic subdural hematomas. Sud Med Ekspert. 1999;42(1):11–14. (In Russ.). [Пиголкин Ю.И., Касумова С.В., Романов А.Н. Морфологическая характеристика хронических субдуральных гематом. Судебно-медицинская экспертиза. 1999;42(1):11–14]. PMID: 10191690
  8. Park MH, Kim CH, Cho TG, Park JK, Moon JG, Lee HK. Clinical Features According to the Histological Types of the Outer Membrane of Chronic Subdural Hematoma. Korean J Neurotrauma. 2015;11(2):70–4. doi: 10.13004/kjnt.2015.11.2.70

Supplementary files

Supplementary Files
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1. JATS XML
2. Figure 1. Non-encapsulated SH. The contents of the hematoma do not include fibrin and are not soldered to the dura mater. Staining with hematoxylin and eosin. 64x.

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3. Figure 2. SH capsule with multiple recurrent intracapsular bleeding. There is a fusion of the recurrent intracapsular bleedings with the separation of the capsule from the dura mater and the formation of an intracapsular cavity filled with blood. Staining with hematoxylin and eosin. 129x.

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4. Figure 3. The capsule of a stably organized SH. Staining with hematoxylin and eosin. 129x.

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5. Figure 4. Secondary encapsulated SH. It consists of the remains of the capsule of an organized primary SH, which has a structure similar to that of the dura mater (the boundaries of the capsule are marked with horizontal arrows) and blood overlays of the repeated acute SH. In the capsule, there is a visible vessel of meta-arteriole type (marked by the vertical arrow). Staining with hematoxylin and eosin. 129x.

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6. Figure 5. Artifactually resorbed SH. The border between the hematoma capsule and the dura mater is marked with an arrow. Staining with hematoxylin and eosin. 129x.

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Copyright (c) 2020 Nedugov G.V., Fedorina T.A.

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