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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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ACE Inhibitors are associated with higher hematoma volume in patients with chronic subdural hematoma

Meeting Abstract

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  • Marian C. Neidert - Klinik für Neurochirurgie, UniversitätsSpital Zürich, Schweiz
  • Jan-Karl Burkhardt - Klinik für Neurochirurgie, UniversitätsSpital Zürich, Schweiz
  • Jorn Fierstra - Klinik für Neurochirurgie, UniversitätsSpital Zürich, Schweiz
  • Tobias Schmidt - Klinik für Neurochirurgie, UniversitätsSpital Zürich, Schweiz
  • Tatyana Mitova - Klinik für Neurochirurgie, UniversitätsSpital Zürich, Schweiz
  • Luca Regli - Klinik für Neurochirurgie, UniversitätsSpital Zürich, Schweiz
  • Oliver Bozinov - Klinik für Neurochirurgie, UniversitätsSpital Zürich, Schweiz

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMO.19.02

doi: 10.3205/14dgnc109, urn:nbn:de:0183-14dgnc1093

Published: May 13, 2014

© 2014 Neidert et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Bradykinin is a vasoactive peptide that plays an important role in the pathophysiology of chronic subdural hematoma (cSDH) and is known to be elevated in patients treated with angiotensin-converting enzyme (ACE) inhibitors. We aim to analyze the influence of ACE inhibitors on initial presentation and outcome of patients with cSDH.

Method: We included 206 consecutive patients treated for cSDH between 2009 and 2013. Patient charts were reviewed retrospectively and data were analyzed using descriptive statistics as well as univariate and multivariate logistic regression.

Results: Out of 206 patients (58 females, mean age 73.2 years), 53 (26%) patients were on ACE inhibitors before their presentation with cSDH. Median initial hematoma volume in individuals with ACE inhibitors (169.6ml±13.3ml SEM) was significantly higher compared to patients without ACE inhibitors (138.7ml±6.3ml; p=0.016). There was a trend towards an increased probability of repeat surgery in the ACE inhibitor group (12/53, 23% vs. 19/153, 12%; p=0.079).

Conclusions: We hypothesize that the increased initial hematoma volume and the higher rate of repeat surgeries in cSDH patients on ACE inhibitors is due to ACE inhibitor induced bradykinin elevation causing increased vascular permeability of the highly vascularized neomembranes in cSDH.