• Zhi-Qiang Tao, Sheng-Hong Ding, Jian-Yue Huang, and Zhi-Gang Zhu.
• Department of Neurosurgery, Yiwu Central Hospital, Wengzhou Medical College, Yiwu, China. Electronic address: 266181@163.com.
• World Neurosurg. 2018 Jun 1; 114: e22-e28.

ObjectiveTo discuss the pathologic mechanism of subacute subdural hematoma (sASDH).MethodsThree typical cases of sASDH were reported, and related literature in Chinese published in the past 15 years was reviewed.ResultsIntervals from onset of acute subdural hematoma to surgery or symptom deterioration resulting in sASDH were 12.5-15.5 days (mean 14.1 days). Delayed liquefaction of hematoma clots occurred in all 3 reported cases. One patient achieved good curative effect after administration of dexamethasone, and another patient relapsed owing to poor drainage after evacuation of hematoma.ConclusionsThe conversion of acute subdural hematoma to sASDH is an inflammatory reaction process with very regular in time, and it is speculated that the pathologic mechanism may be a delayed hypersensitivity reaction. Antigen released during the liquefaction process of blood clot, with subdural neomembrane cells as antigen-presenting cells, is presented to the T lymphocytes released from the capillaries in the neomembrane and forms sensitized T lymphocytes. When the subsequent antigen is released from the blood clots with a delayed liquefaction and is exposed to sensitized T lymphocytes, the delayed hypersensitivity process occurs.Copyright © 2018 Elsevier Inc. All rights reserved.

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