Rapid Spontaneous Resolution of Large Acute Subdural Hematoma

Abstract

Usually, acute subdural hematomas (ASDHs) result from head trauma and require urgent surgical treatment. However, there have been many reports of rapid spontaneous resolution of ASDHs since 1986. Recently, we experienced a case of a massive ASDH that resolved spontaneously within 1.5 days. A 76-year-old man was admitted to a local hospital after a head injury. According to his clinical records, his initial neurologic status was good (Glasgow Coma Scale score of 14). However, his head computer tomography (CT) scan demonstrated a massive ASDH to the right, with a significant midline shift. Based on his neurological status and general condition, surgery was not considered, and the patient was closely monitored in the intensive care unit. The next day, the patient was transferred to our hospital as requested by his family, after which his neurological state stabilized, and the customary follow-up brain CT was performed. It was about 32 hours after the patient's head injury, and it revealed an unexpected finding, near-total resolution of the ASDH. Herein, we review previously reported similar cases and relevant mechanisms of rapid resolution of the ASDH. We believe that neurosurgeons should comprehensively assess the patient's condition and CT findings and provide appropriate treatment, especially when surgical intervention is unnecessary.

Rapid Spontaneous Resolution of Contralateral Lentiform Acute Subdural Hematoma After Burr Hole Trephination for Chronic Subdural Hematoma

“…Although the true incidence of rapid spontaneous resolution or redistribution of ASDH is unknown, it can occur very rarely. 7 12 17 19) Rathore et al 12) have reviewed their 5 cases of rapid spontaneous resolution of ASDH within 72 hours and 39 such cases reported previously. In their review, radiological findings of resolution of ASDH or clot reduction started at 1 hour after trauma.…”

“…Although the exact mechanism of this phenomenon has not been identified yet, 2 popular hypotheses have been proposed. 7 12 17) One hypothesis is that ASDH does not really disappear from the SDS. 7 12 17) Rather, it is redistributed along the SDS.…”

“… 7 12 17) One hypothesis is that ASDH does not really disappear from the SDS. 7 12 17) Rather, it is redistributed along the SDS. 7 12 17) ASDH might be compressed by the pressure from underlying cerebral swelling or edema and increased ICP, resulting in redistribution of ASDH along the SDS.…”

“… 7 12 17) Rather, it is redistributed along the SDS. 7 12 17) ASDH might be compressed by the pressure from underlying cerebral swelling or edema and increased ICP, resulting in redistribution of ASDH along the SDS. 7 12 17) In addition, increased ICP due to ASDH can decrease brain compliance.…”

“… 11 14) Although rare, ASDH may disappear spontaneously within a short time without surgery. 7 12 17 19) …”