gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Symptomatic chronic subdural hematoma – Why are brain natriuretic peptide serum levels at admission high?

Symptomatisches chronisches Subduralhämatom – warum sind BNP-Werte bei Aufnahme erhöht?

Meeting Abstract

  • presenting/speaker Mehdi Chihi - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Ramazan Jabbarli - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Ahmet Parlak - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Marvin Darkwah Oppong - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Homajoun Maslehaty - St. Vinzenz Hospital, Neurochirurgie, Dinslaken, Deutschland
  • Oliver Gembruch - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Karsten Henning Wrede - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV272

doi: 10.3205/21dgnc258, urn:nbn:de:0183-21dgnc2581

Published: June 4, 2021

© 2021 Chihi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Brain natriuretic peptide serum levels (BNP) on admission are frequently elevated in patients with symptomatic chronic subdural hematoma (cSDH). However, the reasons for these elevated levels remain unclear. In patients with traumatic brain injuries, elevated BNP was associated with increased intracranial pressure (ICP), but cSDH exhibits unsteady expansion due to intermittent neomembrane microhemorrhages and fluid exudation, making ICP increases inconsistently. In addition, recent histopathological studies have demonstrated that immature cSDH neomembranes with increased microbleedings result in both the rapid expansion of small hematomas and worse clinical presentations. Therefore, the purpose of this study was to identify predictors of elevated BNP in symptomatic cSDH.

Methods: Patients with unilateral symptomatic cSDH who were surgically treated in our department between November 2016 and May 2020 and had a head trauma event for >3 weeks were enrolled in this study. BNP was measured on admission, and patients’ neurological conditions and symptoms were prospectively assessed using a study questionnaire. Preoperative hematoma volumes (Hem-Vol) and midline shifts were measured on initial computer tomography to assess the degree of brain compression. BNP values were log10-transformed for a normal distribution to assess linearity with Hem-Vol values. These clinical and radiographic cSDH findings were then compared to a cohort of patients with isolated unilateral traumatic 4acute SDH (aSDH), characterized by a rapid hematoma expansion, who were admitted during the same period with head-trauma events within 24 hours of admission.

Results: In total, 212 patients were analyzed (cSDH: n=100; aSDH n=112). A linear regression analysis showed that higher log10BNP values were significantly associated with smaller Hem-Vol values in cSDH patients (p=0.003); but in aSDH patients with larger values (p=0.014). A multivariate analysis revealed that the presence of a neurological deficit (aOR=8.9, p=0.001), a smaller Hem-Vol value (p=0.037), and advanced age (p=0.004) were all independent predictors of elevated BNP in cSDH patients.

Conclusion: Elevated BNP in symptomatic cSDH patients is not related to a higher degree of brain compression as in aSDH, but instead to smaller hematoma volumes and the presence of neurological deficits. These represent two arguments in favor of cSDH immaturity prompting hematoma expansion. Further histopathological prospective studies are needed to validate our findings.