The pathophysiology of brain swelling associated with subdural hemorrhage

the role of the trigeminovascular system

Waney Squier, Julie Mack, Alex Green, Tipu Aziz

Research output: Contribution to journalReview article

18 Citations (Scopus)

Abstract

This paper reviews the evidence in support of the hypothesis that the trigeminal system mediates brain swelling associated with subdural bleeding. The trigeminovascular system has been extensively studied in migraine; it may play an important but under-recognized role in the response to head trauma. Nerve fibers originating in trigeminal ganglion cells are the primary sensors of head trauma and, through their collateral innervation of the intracranial and dural blood vessels, are capable of inciting a cascade of vascular responses and brain swelling. The extensive trigeminal representation in the brainstem initiates and augments autonomic responses. Blood and tissue injury in the dura incite neurogenic inflammatory responses capable of sensitizing dural nerves and potentiating the response to trauma. Discussion The trigeminal system may provide the anatomophysiological link between small-volume, thin subdural bleeds and swelling of the underlying brain. This physiology may help to explain the poorly understood phenomena of "second-impact syndrome," the infant response to subdural bleeding (the "big black brain"), as well as post-traumatic subdural effusions. Considerable age-specific differences in the density of dural innervation exist; age-specific responses of this innervation may explain differences in the brain's response to trauma in the young. An understanding of this pathophysiology is crucial to the development of intervention and treatment of these conditions. Antagonists to specific neuropeptides of the trigeminal system modify brain swelling after trauma and should be further explored as potential therapy in brain trauma and subdural bleeding.

Original languageEnglish (US)
Pages (from-to)2005-2015
Number of pages11
JournalChild's Nervous System
Volume28
Issue number12
DOIs
StatePublished - Dec 1 2012

Fingerprint

Subdural Hematoma
Brain Edema
Wounds and Injuries
Hemorrhage
Craniocerebral Trauma
Blood Vessels
Subdural Effusion
Trigeminal Ganglion
Brain
Neuropeptides
Migraine Disorders
Nerve Fibers
Brain Stem
Therapeutics

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

@article{79b0de51cea1458c9fcd606a55a229b1,
title = "The pathophysiology of brain swelling associated with subdural hemorrhage: the role of the trigeminovascular system",
abstract = "This paper reviews the evidence in support of the hypothesis that the trigeminal system mediates brain swelling associated with subdural bleeding. The trigeminovascular system has been extensively studied in migraine; it may play an important but under-recognized role in the response to head trauma. Nerve fibers originating in trigeminal ganglion cells are the primary sensors of head trauma and, through their collateral innervation of the intracranial and dural blood vessels, are capable of inciting a cascade of vascular responses and brain swelling. The extensive trigeminal representation in the brainstem initiates and augments autonomic responses. Blood and tissue injury in the dura incite neurogenic inflammatory responses capable of sensitizing dural nerves and potentiating the response to trauma. Discussion The trigeminal system may provide the anatomophysiological link between small-volume, thin subdural bleeds and swelling of the underlying brain. This physiology may help to explain the poorly understood phenomena of {"}second-impact syndrome,{"} the infant response to subdural bleeding (the {"}big black brain{"}), as well as post-traumatic subdural effusions. Considerable age-specific differences in the density of dural innervation exist; age-specific responses of this innervation may explain differences in the brain's response to trauma in the young. An understanding of this pathophysiology is crucial to the development of intervention and treatment of these conditions. Antagonists to specific neuropeptides of the trigeminal system modify brain swelling after trauma and should be further explored as potential therapy in brain trauma and subdural bleeding.",
author = "Waney Squier and Julie Mack and Alex Green and Tipu Aziz",
year = "2012",
month = "12",
day = "1",
doi = "10.1007/s00381-012-1870-1",
language = "English (US)",
volume = "28",
pages = "2005--2015",
journal = "Child's Nervous System",
issn = "0256-7040",
publisher = "Springer Verlag",
number = "12",

}

The pathophysiology of brain swelling associated with subdural hemorrhage : the role of the trigeminovascular system. / Squier, Waney; Mack, Julie; Green, Alex; Aziz, Tipu.

In: Child's Nervous System, Vol. 28, No. 12, 01.12.2012, p. 2005-2015.

Research output: Contribution to journalReview article

TY - JOUR

T1 - The pathophysiology of brain swelling associated with subdural hemorrhage

T2 - the role of the trigeminovascular system

AU - Squier, Waney

AU - Mack, Julie

AU - Green, Alex

AU - Aziz, Tipu

PY - 2012/12/1

Y1 - 2012/12/1

N2 - This paper reviews the evidence in support of the hypothesis that the trigeminal system mediates brain swelling associated with subdural bleeding. The trigeminovascular system has been extensively studied in migraine; it may play an important but under-recognized role in the response to head trauma. Nerve fibers originating in trigeminal ganglion cells are the primary sensors of head trauma and, through their collateral innervation of the intracranial and dural blood vessels, are capable of inciting a cascade of vascular responses and brain swelling. The extensive trigeminal representation in the brainstem initiates and augments autonomic responses. Blood and tissue injury in the dura incite neurogenic inflammatory responses capable of sensitizing dural nerves and potentiating the response to trauma. Discussion The trigeminal system may provide the anatomophysiological link between small-volume, thin subdural bleeds and swelling of the underlying brain. This physiology may help to explain the poorly understood phenomena of "second-impact syndrome," the infant response to subdural bleeding (the "big black brain"), as well as post-traumatic subdural effusions. Considerable age-specific differences in the density of dural innervation exist; age-specific responses of this innervation may explain differences in the brain's response to trauma in the young. An understanding of this pathophysiology is crucial to the development of intervention and treatment of these conditions. Antagonists to specific neuropeptides of the trigeminal system modify brain swelling after trauma and should be further explored as potential therapy in brain trauma and subdural bleeding.

AB - This paper reviews the evidence in support of the hypothesis that the trigeminal system mediates brain swelling associated with subdural bleeding. The trigeminovascular system has been extensively studied in migraine; it may play an important but under-recognized role in the response to head trauma. Nerve fibers originating in trigeminal ganglion cells are the primary sensors of head trauma and, through their collateral innervation of the intracranial and dural blood vessels, are capable of inciting a cascade of vascular responses and brain swelling. The extensive trigeminal representation in the brainstem initiates and augments autonomic responses. Blood and tissue injury in the dura incite neurogenic inflammatory responses capable of sensitizing dural nerves and potentiating the response to trauma. Discussion The trigeminal system may provide the anatomophysiological link between small-volume, thin subdural bleeds and swelling of the underlying brain. This physiology may help to explain the poorly understood phenomena of "second-impact syndrome," the infant response to subdural bleeding (the "big black brain"), as well as post-traumatic subdural effusions. Considerable age-specific differences in the density of dural innervation exist; age-specific responses of this innervation may explain differences in the brain's response to trauma in the young. An understanding of this pathophysiology is crucial to the development of intervention and treatment of these conditions. Antagonists to specific neuropeptides of the trigeminal system modify brain swelling after trauma and should be further explored as potential therapy in brain trauma and subdural bleeding.

UR - http://www.scopus.com/inward/record.url?scp=84871245415&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84871245415&partnerID=8YFLogxK

U2 - 10.1007/s00381-012-1870-1

DO - 10.1007/s00381-012-1870-1

M3 - Review article

VL - 28

SP - 2005

EP - 2015

JO - Child's Nervous System

JF - Child's Nervous System

SN - 0256-7040

IS - 12

ER -