Rapid Spontaneous Resolution of Acute Subdural Hematoma in a Patient with Liver Cirrhosis

Abstract

Acute subdural hematoma (ASDH) constitutes one of the most critical emergencies in neurosurgery and rapid spontaneous resolution of ASDH is an infrequent phenomenon. Several mechanisms have been attributed to explain this phenomenon including redistribution of subdural blood, dilution by cerebral spinal fluid and brain atrophy. Rapid resolution of ASDH related to coagulopathy is a rare phenomenon; to our knowledge, only one case has been reported. We report on a patient who showed rapid resolution of ASDH with coagulopathy and also discuss such a rare case with speculation of the coagulopathy as a factor to promote this phenomenon.

Spontaneous Resolution of Acute Subdural Hematoma with a Good Clinical Outcome: A Case Report

“…A simple ASDH with moderate thickness and visible "lowdensity band" between the hematoma and inner table of the skull on CT could be an indicator of the spontaneous resolution of hematoma, as suggested by other authors 2,8,12,14,17,19,21,22) . Other factors such as brain atrophy and coagulopathy due to previous medical conditions could also be responsible for spontaneous resolution (Table 1).…”

“…The laboratory evidence of coagulopathy with international normalized ratio prolongation might have played a role, since the patient was taking warfarin for his heart condition, eliciting liquefaction of the hematoma and may have promoted redis-tribution. In addition, the presence of brain atrophy due to his previous history of cerebral infarction and old age might have rendered some space to compensate for the acute IICP before brain herniation began, as a similar phenomenon suggested by other cases 2,5,12,17,20,21) . It has been suggested that the use of antiplatelet agents prior to head injury could increase the probability of rapid resolution.…”

“…In his study, the pre-hospital use of antiplatelet agents and the presence of a low-density band between the hematoma and inner skull bone on initial CT could be associated with liquefaction of the hematoma, thus encouraging rapid spontaneous resolution by facilitating redistribution with brain swelling. Other studies also supported this hypothesis, although brain atrophy instead of brain swelling is suggested as a main contributor in the process of dilution and redistribution 2,20) .…”

“…However, there could be situations in the clinical field where surgical intervention is not performed for various reasons such as poor initial medical status and family wishes or a patient's will. Several case reports have shown patients whose ASDH resolved rapidly and spontaneously within hr to days with good clinical outcomes, as demonstrated by CT [1][2][3]5,8,10,12,14,15,17,[19][20][21][22] . We report a rare case of ASDH with a significant midline shift that resolved spontaneously under conservative treatment.…”

“…Since ASDH with severe mass effect and neurologic symptoms almost always undergo immediate decompressive surgery, the observation of its natural clinical course is restricted to patients chosen for conservative treatment. There have been reported cases where the rapid resolution of ASDH showing neurological improvements with conservative treatment [1][2][3]5,8,10,12,14,15,17,[19][20][21][22] .…”