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

Abstract

Acute subdural hematoma (ASDH) usually occurs with severe traumatic head injury, which could result in neurologic deteriorations and/or intracranial hypertension, requiring emergency decompression surgery. Even after vigorous medical treatment, ASDH with poor neurologic status and severe midline shift with brain herniation could bring a serious socioeconomic loss to patients and their families, and death is generally expected without surgical intervention. Here, we report a case of a 74-year-old man with ASDH who spontaneously disappeared under conservative treatment and discuss the possible mechanisms with a literature review.

Rapid spontaneous resolution of the acute subdural hematoma: Case series and review of literature

“…Some cases of rapid resolution of clot have been found associated with coagulopathy. [ 20 24 ] The possible explanation could be, coagulopathy prevents formation of well-organized clot, making it susceptible to redistribution by CSF dilution. [ 24 ] The possible association of middle cranial fossa arachnoid cyst and posterior fossa cyst in dandy walker malformation has been mentioned in the literature.…”

“…Rapid neurological improvement within 24 h of injury has been documented in 27 out of total 44 cases. [ 2 4 5 6 7 8 9 11 13 20 22 23 25 26 27 30 31 34 36 37 ] While waiting for surgery, a rapid neurological improvement, in patients with ASDH, may hint at the possibility of spontaneous resolution or reduction of hematoma. We suggest a repeat radiological workup in such cases (CT scan head) before proceeding for surgery.…”

Rapid Spontaneous Resolution of Large Acute Subdural Hematoma

“…So called “low-density band” between ASDH and skull seen in CT scan suggests such CSF collection. 2 3 4 5 6 7 8 9 10 11 12 13 16 17 19 20) 2) Redistribution of hematoma to another space; contralateral intracranial space, intradiploic space and/or subgaleal space through the skull fracture, spinal subdural space, by raised pressure caused by brain swelling, other intracranial hemorrhages, and/or subdural hematoma itself. 1 3 4 5 6 7 8 9 10 11 12 13 14 16 17 19 20) It has been claimed also that brain atrophy leads to widening of subarachnoid space, which facilitates the removal of ASDH by aiding the redistribution of the hematoma.…”

“… 2 3 4 5 6 7 8 9 10 11 12 13 16 17 19 20) 2) Redistribution of hematoma to another space; contralateral intracranial space, intradiploic space and/or subgaleal space through the skull fracture, spinal subdural space, by raised pressure caused by brain swelling, other intracranial hemorrhages, and/or subdural hematoma itself. 1 3 4 5 6 7 8 9 10 11 12 13 14 16 17 19 20) It has been claimed also that brain atrophy leads to widening of subarachnoid space, which facilitates the removal of ASDH by aiding the redistribution of the hematoma. 1 5 8 12 13 19) Lee et al 12) suggest that the expanded subarachnoid space due to brain atrophy can be a favorable factor which could affect the dilution and redistribution of the hematoma.…”

“… 1 3 4 5 6 7 8 9 10 11 12 13 14 16 17 19 20) It has been claimed also that brain atrophy leads to widening of subarachnoid space, which facilitates the removal of ASDH by aiding the redistribution of the hematoma. 1 5 8 12 13 19) Lee et al 12) suggest that the expanded subarachnoid space due to brain atrophy can be a favorable factor which could affect the dilution and redistribution of the hematoma. In addition, coagulopathy or premorbid ingestion of antiplatelet agent or anticoagulant is another ancillary factor contributes to rapid resolution.…”