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The morphology of the outer and inner membranes of traumatic chronic subdural hematomas (CSDHs) surgically removed from eight patients was investigated by scanning electron microscopy (SEM). Hematomas were divided into three groups based on time that had passed from the initiation of trauma to surgery. Structure of the CSDHs showed gradual morphological changes of the developing hematoma capsule. They initially included angiogenic and aseptic inflammatory reactions followed by progressive involvement of fibroblasts—proliferating and producing collagen fibrils. Numerous capillaries suggesting formation of new blood vessels were observed mainly in young hematomas removed between 15 and 21 days after trauma. In “older” hematomas (40 days after trauma), more numerous capillaries and thin-walled sinusoids were accompanied by patent, larger diameter blood vessels. Within the fibrotic outer membrane of the “oldest” hematoma capsules (60 or more days after trauma), especially in the area over the hematoma cavity, blood vessels were frequently occluded by clots. The results suggest dynamic changes in cellular and vascular organization of traumatic CSDH capsules paralleling the progression in hematoma age.

We performed this study to determine whether in head injured patients body temperature rhythmicity exists outside the usual spectrum. Temperature data of in total 22 patients with head injury were analyzed using the Regressive and Iterative Cosinor methods. We found that circadian rhythm often remained, and usually was combined with rhythms in ultradian or infradian ranges. Tau shifts over consecutive days were observed in three severely head injured patients (Glasgow Coma Scale score ≤ 8). To validate the results we used surrogate data. Detection of temperature rhythms in this study may serve to estimate the clinical importance of biological rhythms in head injury.