The mechanisms accounting for the development of tissue damage following
traumatic brain injury (TBI) have been studied for several decades. A variety of mediators, such as
vascular endothelial growth factor (
VEGF) and
matrix metalloproteinase-9 (MMP-9), which play a crucial role in
edema formation after TBI, have been identified. We experienced a case of
brain edema that progressed continuously at least until 13 days after
head injury. The
brain edema occurred around the
hemorrhage from an intracerebral
contusion. The evacuated
hematoma was investigated based on the inference that the unexpected expansion of
edema was induced by the mediators within the
hematoma itself. A 64-year-old woman was admitted to our hospital following a traffic injury. Left
brain contusion was revealed by head computed tomography (CT) on admission. Three hours later, formation of an intracerebral
hematoma became evident. Serial CT examination revealed that
brain edema had developed progressively till 13 days after the injury. A
hematoma removal operation was performed on Day 13. The
hematoma was centrifuged and the supernatant was analyzed for the expression of
VEGF and MMP-9. The values of both (4400 pg/ml and 920 ng/ml, respectively) were extremely high compared with values reported previously in serum and cerebrospinal fluid collected from patients with intracranial
infection or injury. This case suggested that the delayed exacerbation of
edema following
traumatic intracranial hemorrhage was possibly induced by secretory factors such as
VEGF and MMP-9 released from within and around the
hematoma.