Experimental acute subdural hematoma in infant piglets.

Traumatic acute subdural hematoma is associated with high mortality in the pediatric population, yet the pathophysiology remains poorly understood. The objective of this study was to develop a pediatric model of acute subdural hematoma, and to evaluate the resultant histopathological changes in the brain. Ten 3-week-old piglets were studied. A 5-mm craniotomy was made in the right frontal skull. A small silastic tube was inserted through the underlying intact dura into the subdural space. A craniotomy was made posterior to the right coronal suture with underlying dura left intact (closed cranial window model). Injection of 5 ml autologous, nonheparinized blood was accomplished through the silastic tube. Animals were sacrificed after 72 h or 1 week. During the subdural injection, intracranial pressure rose to 62 +/- 8 mm Hg, and returned to baseline within 1 h of surgery. Mean arterial blood pressure increased transiently. Cresyl violet and hematoxylin and eosin staining demonstrated extensive areas of white matter necrosis under the hematoma after 72 h survival (n = 7). Zones of necrosis were also noted in cortex, but were less extensive than those seen in white matter. These results differ from adult rodent models in which cortex is primarily affected. This is the first reported pediatric model of traumatic acute subdural hematoma. This model can be used in future studies to investigate pharmacological or other therapies which may improve outcome after this type of injury.

Neuroprotection by dextromethorphan in acute experimental subdural hematoma in the rat.

Experimental acute subdural hematoma in the rat has been shown to produce a zone of apparent infarction under the clot, and excitatory amino acid toxicity appears to play a role in the damage observed. We report the effect of dextromethorphan, a commonly used antitussive and a noncompetitive NMDA-type glutamate receptor antagonist, on the volume of histologic damage seen at 72 h after acute subdural hematoma in the rat. Sixty-five Long-Evans rats underwent placement of acute subdural hematoma using the "cranial window" model. Fourteen animals received oral dextromethorphan, 10 mg/kg/dose, twice daily for 3 days, and an additional 20 animals also received a single 20 mg/kg intraperitoneal dose 15 min after clot placement in addition to the oral regimen. Control animals received equal volumes of sterile water. Brain lesions in all animals were characterized by well-circumscribed infarctions underlying the subdural hematoma. Lesion volume in control animals was 88.3 +/- 9.3 mm3 (mean +/- standard error of the mean), while animals receiving dextromethorphan had significantly smaller lesions, which was independent of dosing schedule (59.9 +/- 9.2 mm3)(p = 0.0403). Animal weight was also found to be a significant covariate (p = 0.038). Because of its safety in humans and efficacy as a neuroprotectant in a variety of models, dextromethorphan may be a promising agent for clinical use, particularly in children.

Deep hypothermia diminishes the ischemic induction of heat-shock protein-72 mRNA in piglet brain.

BACKGROUND AND PURPOSE: Expression of the 72-kD heat-shock protein (HSP72) has served as a useful indicator of ischemic stress after cerebral ischemia. Moderate hypothermia (30 degrees C) has been reported to block the induction of HSP72 after a brief episode of forebrain ischemia. The objective of the present study was to examine the effects of deep hypothermia (15 degrees C) on expression of HSP72 after a prolonged period of cerebral ischemia. METHODS: Piglets 19 to 23 days old, were placed on cardiopulmonary bypass, and brain temperature was lowered to 23 degrees C (n = 9) or 15 degrees C (n = 9) before circulatory arrest for 1 hour. In an additional group of animals (n = 5), the temperature was lowered to 29 degrees C before arrest for 45 minutes. All animals were reperfused at 37 degrees C for 2 hours, and the regional expression of HSP72 mRNA was assessed using in situ hybridization. RESULTS: After ischemia at 15 degrees C, expression of HSP72 mRNA was limited to a few scattered regions of cerebral cortex; the percentage of cortex exhibiting HSP72 mRNA was 23 +/- 7% (mean +/- SEM). Ischemia at 23 degrees C triggered expression of HSP72 mRNA in a significantly larger portion of the cortex (68 +/- 8%, P < .001). Ischemia at 29 degrees C failed to induce substantial expression of HSP72 mRNA in the cerebral cortex. CONCLUSIONS: These results suggest that, relative to ischemia at 23 degrees C, deep hypothermia (15 degrees C) diminishes ischemic alterations leading to induction of HSP72 mRNA. The lack of cortical expression of HSP72 mRNA following ischemia at 29 degrees C may be secondary to inadequate recovery of energy metabolism.

Acute subdural hematoma: is the blood itself toxic?

Recently developed rodent models of acute subdural hematoma have shown an associated large area of infarction underlying the clot. Excitotoxic processes have been postulated to play an important role in the extensive cell death seen with these models. However, whether increased pressure, vasoactive effects, or toxicity of the blood itself is responsible for initiating or sustaining these processes remains unclear. To study the effect of blood itself, an opaque layer of autologous clot was placed on the widely exposed parietal cortex of 15 Long-Evans rats and left in place for 72 h. In control animals the cortical surface was exposed but no blood was placed and contact with blood products was carefully limited. These animals were compared to a group in whom blood was injected into the closed subdural space. Histologic analysis showed that the majority of the cortex in both control and experimental animals in the open cranial model group appeared normal. Scattered small, discrete hemorrhagic lesions on the cortical surface of both control and experimental animals were seen, which had the appearance of focal mechanical trauma or vessel avulsion. There was no significant difference in average volume of lesions between experimental and control animals (9.1 versus 9.7 mm3, p = 0.85). No areas of infarction or selective neuronal loss were seen. In comparison, animals in which blood was injected into the subdural space had significantly larger lesions underlying clot, averaging 133.6 mm3 in volume (p < 0.0003). Blood in prolonged contact with the cortical surface in the absence of increased pressure, ischemia, or other insult is insufficient to cause underlying infarction like that seen when a similar volume of blood is injected into the closed subdural space.