Rapid Spontaneously Resolving Acute Subdural Hematoma

Abstract

Introduction:This study reports a rare patient of a rapid spontaneously resolving acute subdural hematoma. In addition, an analysis of potential clues for the phenomenon is presented with a review of the literature.Patient Presentation:A 1-year-and-2-month-old boy fell from a height of approximately 2 m. The patient was in a superficial coma with a Glasgow Coma Scale of 8 when he was transferred to the authors’ hospital. Computed tomography revealed the presence of an acute subdural hematoma with a midline shift beyond 1 cm. His guardians refused invasive interventions and chose conservative treatment. Repeat imaging after 15 hours showed the evident resolution of the hematoma and midline reversion. Progressive magnetic resonance imaging demonstrated the complete resolution of the hematoma, without redistribution to a remote site.Conclusions:Even though this phenomenon has a low incidence, the probability of a rapid spontaneously resolving acute subdural hematoma should be considered when patients present with the following characteristics: children or elderly individuals suffering from mild to moderate head trauma; stable or rapidly recovered consciousness; and simple acute subdural hematoma with a moderate thickness and a particularly low-density band in computed tomography scans.

Intracranial Acute Subdural Hematoma: Is there a Space for a Conservative Treatment in the Elderly?

“…Moreover, patients surgically treated after an initial conservative management, had a better outcome than patients operated emergently, although this data didn't reach a statistical significance. Bajsarowicz, in his large series investigated the risk factors correlates for the necessity of a delayed surgical evacuation in patients with an ASH managed conservatively at the admission [13]. In this study, only 6.5% of patients required a delayed surgical intervention.…”

“…Similarly, in his retrospective study, Kim analyzed the risk factors associated with a delayed surgical evacuation of ASHs after a mild head injury treated conservatively on admission. [13] Thirty-five per cent of patients had undergone a deferred surgery, after a mean of 17 days. The volume of the hematoma and the midline shift were identified as negative prognostic factors.…”

“…A proposed theory is related to the increasing subarachnoid compartment secondary with the brain atrophy: tears of the subarachnoid membrane after the head trauma may play a role in the gradual resolution of the hematoma by diluting it, reducing its mass effect and eventually lowering the risk of the hematoma progression [13][14][15]. In the same study, Kim reported a reduced incidence of ASDH progression in case of concurrent brain contusions and SAH.…”

“…In 15 cases (88%), ASH developed in the whole convexity (fronto-temporo-parietal); moreover, there was 1 occipital and 1 interhemispheric ASH. All ASHs had a thickness greater than 10 mm, with a mean of 12 mm (range [11][12][13][14][15]. The mean midline shift was 4 mm (range 3-10).…”

Intervention of Peiyuan Huayu Decoction on the neuron damage in model rats with acute subdural hematoma

“…ASDH is a common intracranial space-occupying lesion after acute craniocerebral injury, it usually appears with brain contusion,brain hematoma and others at the same time, only 30-40% of the pure ASDH requires surgical treatment [4,5], and non-surgical treatment will still be a feasible method for some patients [6], such as children or the elderly who have ASDH caused by minor damage, or the ASDH with quick restoration of consciousness after injury [7].…”