Impact of Impaired Glucose Metabolism on Organization in Chronic Subdural Hematoma: An Integrated Clinical, Bioinformatic, and Histopathological Analysis

Organized chronic subdural hematoma (OCSDH) is an uncommon form of chronic subdural hematoma, and its relationship with impaired glucose metabolism is unclear. We combined a review of published cases with a single-center retrospective cohort of 60 patients treated from November 2021 to March 2026. After exclusion of three patients with inadequate intraoperative images, 35 patients had conventional chronic subdural hematoma and 22 had OCSDH. Clinical characteristics were compared and multivariable logistic regression was performed. Histopathology and immunohistochemistry were assessed descriptively in one specimen from each group, and public RNA-sequencing datasets were analyzed for differential expression and pathway enrichment. Diabetes mellitus and admission glucose were more frequent or higher in OCSDH, and diabetes mellitus remained associated with OCSDH after adjustment (odds ratio, 11.84; 95% confidence interval, 1.87–75.08; P = 0.009). OCSDH tissue showed early thrombus, fibrous septa, inflammatory infiltration, and greater CD34-, CD68-, and VEGF-positive areas in the hematoma mass. Transcriptomic analyses implicated hypoxia/HIF-1 signaling, altered RNA and protein processing, and reduced lysosomal, autophagy, and FoxO-related homeostasis. These findings support pathological angiogenesis, impaired hematoma clearance, and fibrotic remodeling as testable hypotheses, but do not establish causality.