Ebook Corticosteroids and steroid therapy: Part 2
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Ebook Corticosteroids and steroid therapy: Part 2
In: Corticosteroids and Steroid TherapyISBN: 978-1 -63482-308-1Editor: Carmen Adkins© 2015 Nova Science Publishers. Inc.Chapter 3The Role of Steroids Ebook Corticosteroids and steroid therapy: Part 2 in the Management of Chronic Subdural Hematoma: Principles and Clinical ConsiderationsJulio Plata HelloHospital Universilario de Canarias (Department of Neurosurgery), s/c de Tenerife, SpainAbstractChronic subdural hematoma (CSDH) is a common condition in the elderly population and one of the most Ebook Corticosteroids and steroid therapy: Part 2frequent lesions encountered in neurosurgical departments.Mild head trauma is reported in most cases, but the pathophysiology of CSDH is still a matteEbook Corticosteroids and steroid therapy: Part 2
r of debate. Several data support the role of inflammatory related factors in the pathogenesis of the lesion, thus CSD1I is considered a chronic self-In: Corticosteroids and Steroid TherapyISBN: 978-1 -63482-308-1Editor: Carmen Adkins© 2015 Nova Science Publishers. Inc.Chapter 3The Role of Steroids Ebook Corticosteroids and steroid therapy: Part 2to be effective. However, there is a large amount of data supporting the use of steroids in the management of CSDH. This data is essentially based on the inflammatory processes that have been postulated as underlying CSDH development.64Julio Plata BelloThe aim of this chapter is to describe the curr Ebook Corticosteroids and steroid therapy: Part 2ent role of steroids in the management of CSDH based on the pathophysiological processes that have been postulated as underlying CSDH development.IntrEbook Corticosteroids and steroid therapy: Part 2
oductionChronic subdural hematoma (CSI)H) is one of the most common diseases seen in routine neurosurgical care. CDSH consists of a slow progressive cIn: Corticosteroids and Steroid TherapyISBN: 978-1 -63482-308-1Editor: Carmen Adkins© 2015 Nova Science Publishers. Inc.Chapter 3The Role of Steroids Ebook Corticosteroids and steroid therapy: Part 2 pathological conditions can cause a build-up of material in this space (e.g., acute subdural hematoma, subdural empyema, pneumoencephahis). The fluid content in cases of CSDII is a combination of cephalous-spinal fluid (CSF) and blood degradation products.The incidence of CSDII is around 13.5 cases Ebook Corticosteroids and steroid therapy: Part 2 per 100.000 individuals per year in the general population. This incidence is even higher when only patients over 65 years of age are considered (estEbook Corticosteroids and steroid therapy: Part 2
imated incidence of 58.1 per 100.000).There arc some risk factors facilitating the development of subdural collections. They include chronic alcohol aIn: Corticosteroids and Steroid TherapyISBN: 978-1 -63482-308-1Editor: Carmen Adkins© 2015 Nova Science Publishers. Inc.Chapter 3The Role of Steroids Ebook Corticosteroids and steroid therapy: Part 2netheless, the origin of (.SDH is usually related with a previous head trauma in 60-80% of cases. The demographics of CSDII may explain the primary events that occur in this entity. On the one hand, brain atrophy, primarily present in elderly people, leads to a larger space between the surface of th Ebook Corticosteroids and steroid therapy: Part 2e brain and the dura matter. Furthermore, bridging veins (i.e., veins that go from the surface of the brain to the dural sinuses) are stretched as a rEbook Corticosteroids and steroid therapy: Part 2
esult of (he aforementioned brain atrophy, thus even a minor head trauma may produce a laceration of a bridging vein and. consequently, a bleeding in In: Corticosteroids and Steroid TherapyISBN: 978-1 -63482-308-1Editor: Carmen Adkins© 2015 Nova Science Publishers. Inc.Chapter 3The Role of Steroids Ebook Corticosteroids and steroid therapy: Part 2t in a specific population age group and it may be facilitated by the pathological conditions of the patients. This text provides a complete description of the CSDH pathophysiology.The collection of fluid in the subdural space can produce brain hemisphere compression and, eventually, result in brain Ebook Corticosteroids and steroid therapy: Part 2 herniation. As there is a slow, progressive accumulation of fluid, CSDH can be clinically silent and theThe Role of Steroids in the Management...65syEbook Corticosteroids and steroid therapy: Part 2
mptoms may appear insidiously, in the form of headache and varying degrees of neurological deficits. Psychiatric disturbances and epileptic seizures aIn: Corticosteroids and Steroid TherapyISBN: 978-1 -63482-308-1Editor: Carmen Adkins© 2015 Nova Science Publishers. Inc.Chapter 3The Role of Steroids Ebook Corticosteroids and steroid therapy: Part 2different stages of CSDII. As suggested by Nomura el al. (1994) [211 the different forms of subdural collection may be of high density (acute subdural haematoma), isodensity (subacute subdural haematoma), low density, mixed density and layering type. The latter three arc considered as the only forms Ebook Corticosteroids and steroid therapy: Part 2 of CSDH. Another noteworthy classification has been proposed by Nakaguchi Ct al. (2001) [19J who defined four groups of haematomas on the basis of CTEbook Corticosteroids and steroid therapy: Part 2
scanning appearance: 1) homogeneous density type; 2) laminar type, defined as a subtype of homogeneous density, with a high density layer along the iIn: Corticosteroids and Steroid TherapyISBN: 978-1 -63482-308-1Editor: Carmen Adkins© 2015 Nova Science Publishers. Inc.Chapter 3The Role of Steroids Ebook Corticosteroids and steroid therapy: Part 2r density type, in which a high -density septum between the inner and the outer membranes appeared against a low-density to isodense background. The difference in appearance could be related with different palhophsyological stages of the CSDII. This aspect will be further discussed in Illis chapter. Ebook Corticosteroids and steroid therapy: Part 2Although spontaneous resolution of CSDH has been described (mostly in small hematomas with no increase of intracranial pressure), surgical treatment iEbook Corticosteroids and steroid therapy: Part 2
s the main treatment option. There arc different available surgical options: onc/two burr holc/s with, without irrigation and with, without drainage; In: Corticosteroids and Steroid TherapyISBN: 978-1 -63482-308-1Editor: Carmen Adkins© 2015 Nova Science Publishers. Inc.Chapter 3The Role of Steroids Ebook Corticosteroids and steroid therapy: Part 2a serious associated morbidity [3]. Apart from surgery, there are also other medical therapies that have been described as useful in treating this condition. Among them, steroids are of specially interest. The importance of using medical therapies for these conditions lies in the possibility of avoi Ebook Corticosteroids and steroid therapy: Part 2ding a surgical procedure in patients where the surgery could be contraindicated and using steroids along with surgery to reduce the incidence of recuEbook Corticosteroids and steroid therapy: Part 2
rrence of the CSDII.Bearing in mind the high incidence of CSDII and its particular pathophysiological features, the aim of this chapter is to describeIn: Corticosteroids and Steroid TherapyISBN: 978-1 -63482-308-1Editor: Carmen Adkins© 2015 Nova Science Publishers. Inc.Chapter 3The Role of Steroids Ebook Corticosteroids and steroid therapy: Part 2e to investigate the effect of steroids in chronic local inflammatory processes.66Julio Plata BelloPhysiopathology of CSDHThe physiopathological mechanisms leading to a CSDH have been much discussed since Virchow's theory about "pachymeningitis" was published in 1857, which is now considered a class Ebook Corticosteroids and steroid therapy: Part 2ic, where the role of inflammation in the development of CSDH was first established. In fact, many authors considered CSDII as a chronic sell-perpetuaEbook Corticosteroids and steroid therapy: Part 2
ting local inflammatory process involving the dura matter, with elevation of pro-inflammatory factors, angiogenic factors and. finally, the formation In: Corticosteroids and Steroid TherapyISBN: 978-1 -63482-308-1Editor: Carmen Adkins© 2015 Nova Science Publishers. Inc.Chapter 3The Role of Steroids Ebook Corticosteroids and steroid therapy: Part 2a bridging vein. This trauma leads to a cleavage of the inner dural layer, creating a space that is normally considered as being virtual (the subdural space) [9, 27J. This subdural space can be created by an injury of the arachnoid membrane, as proposed by other authors [33]. In any case, the collec Ebook Corticosteroids and steroid therapy: Part 2tion of blood and/or cephalic-spinal fluid (CSF) remains in direct contact with the inner dural border cell layer. This mesenchymal cell layer beginsEbook Corticosteroids and steroid therapy: Part 2
to proliferate and to form an inflammatory capsule or membrane around the blood clots or the CSF. This is called the external or outer membrane [16]. In: Corticosteroids and Steroid TherapyISBN: 978-1 -63482-308-1Editor: Carmen Adkins© 2015 Nova Science Publishers. Inc.Chapter 3The Role of Steroids Ebook Corticosteroids and steroid therapy: Part 2. Furthermore, this membrane contains immature vessels, which have a great facility for bleeding. This last circumstance is clinically important, because when a C'SDII is diagnosed signs of acute bleeding appear in the CT and Illis bleeding may be responsible for making the CSDII symptomatic. Theref Ebook Corticosteroids and steroid therapy: Part 2ore, a head trauma may lead to the development of a CSDH by a sequence of events consisting of local inflammation, angiogenesis and bleeding. These evEbook Corticosteroids and steroid therapy: Part 2
ents arc also associated with hypcrcoagulative activity, hyperfibrinolitic activity and increased vasopermeability, thus the local inflammation procesIn: Corticosteroids and Steroid TherapyISBN: 978-1 -63482-308-1Editor: Carmen Adkins© 2015 Nova Science Publishers. Inc.Chapter 3The Role of Steroids Ebook Corticosteroids and steroid therapy: Part 2ytokines in the (.'SDH fluid. Some authors have demonstrated an elevation of IL-6, IL-8 and TNF-a (all of them pro-inflammatory cytokines) in the subdural fluid, while blood tests showed normal levels of these factors [32]. IL-6 is a pleiolrophic cytokine that influences immune and inflammatory resp Ebook Corticosteroids and steroid therapy: Part 2onses and is one of the major physiological mediators of the acute phase reaction [15. 22]. Moreover, a direct pathogenic role of IL-6 in inflammatoryEbook Corticosteroids and steroid therapy: Part 2
angiogenesis and increase permeability has been inferred in other neurological pathological conditions [8]. On the other hand. IL-8 is considered theGọi ngay
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