Pathophysiology of chronic subdural hematoma

Coagulation, fibrinolysis and kinin-kallicrein system disorders could expla in chronic subdural hematoma pathophysiology. The marked decrease in antith rombin III in the hematoma suggest that the decreased levels of clotting fa ctors were caused by excessive coagulation resulting in clotting factors co nsumption. The decrease in alpha2-antiplasmin with the increase of fibrin d egradation products suggest the hyperfibrinolytic activity of the subdural hematoma. Coagulation and fibrinolysis disorders could explain repetitive h emorrhages from the outer membrane, which cause progressive enlargement of the hematoma. Kinin-kallicrein system disorders raise the hemorrhage by its action on the outer membrane. Nowadays, the earliest osmotic theory should reasonably be abandoned.