The cellular composition of chronic subdural hematoma.

INTRODUCTION: The pathophysiology of chronic subdural hematoma (CSDH) remains to be fully understood. Basic knowledge of the composition and features of cells in the CSDH fluid may contribute to the understanding of the seemingly complex processes involved in CSDH formation and recurrence. This study is the first to examine the composition of cells and of cellular features in both systemic blood and subdural fluid from CSDH patients. We hypothesized that the cellular composition and features in the hematoma fluid may be; 1) different from that in the systemic blood; 2) different between patients with and without recurrence; 3) and different between the first and second operation in patients with recurrent CSDH. METHODS: Systemic blood and subdural hematoma fluid were collected from CSDH patients with and without recurrent CSDH at the time of primary and secondary surgery. Analyses of cells and cellular features included total number of white blood cells, erythroblasts, reticulocytes, platelets, neutrophilocytes, lymphocytes, monocytes, eosinophils, basophils, reticulocytes, immature granulocytes, mean corpuscular cell volume (MCV), mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, hemoglobin and hematocrit. RESULTS: Of the 85 included patients, 20 patients were operated for a recurrent CSDH within 90 days follow-up. All cells found in the systemic blood were present in the CSDH fluid, but the composition was different (p < 0.0001). MCV was higher in the hematoma fluid from the primary operation of patients later developing a recurrent CSDH compared to patients not developing recurrence (p = 0.009). Also, the percentage distribution of inflammatory cells in hematoma fluid from patients with recurrent CSDH was different between the first and second operation (p = 0.0017). CONCLUSION: This study is the first to investigate the cellular composition of CSDH fluid. Compared to systemic blood and to a reference distribution, an increased number of immune cells were present in the hematoma fluid, supporting an inflammatory component of the CSDH pathophysiology. MCV was higher in the subdural fluid at time of the first operation of CSDH patients later developing recurrence. CLINICAL TRIAL REGISTRATION: The study was approved by the Scientific Ethical Committee of the Capital Region of Denmark (Journal no. H-20051073.

Aqueous humor cytokines and cellular profiles in pediatric ocular granulomas caused by theTrematode Fluke Procerovum sp.

BACKGROUND: Children from coastal areas of South India develop granulomatous eye disease after swimming in their village ponds, the causative organism being trematode Procerovum. AIM: To understand the pathogenesis by analyzing the cellular profile, cytokines, and chemokines of aqueous fluid. METHODS: This was a prospective study over 1 year on pediatric patients with ocular granuloma caused by a Trematode Fluke Procerovum sp. Granuloma was aspirated along with 100 µl volume of aqueous humor. Immunohistochemical analysis of granuloma was performed. Bio-Plex Pro™ Human Cytokine 17-plex Assay (M5000031YV) was used to measure cytokine and chemokines. RESULTS: The immunohistochemistry revealed predominantly eosinophils, followed by macrophages (CD68+) and T - lymphocytes (CD4+). Both T-helper (Th) 1 and 2 mediated cytokines and chemokine levels were significantly high. As the disease duration increased, direct Th1 response reduced and was replaced by IL-12 and IL-17 mediated secondary Th1 response. CONCLUSION: Procerovum associated granulomatous disease is immunologically characterized by Th1 and Th2 cell-mediated responses. A balance between both arms maintains the eyes between granulomatous inflammation and healing by fibrosis.