Swift Spontaneous Regression of a Pediatric Traumatic Acute Subdural Hematoma

Abstract

We report the case of a 4-year-old girl with acute subdural hematoma who presented to the emergency department after an unwitnessed fall of the balcony. The hematoma was hyperdense along the left convexity of 9 mm thickness with a consequent mass effect with obliteration of the adjacent sulci, left lateral ventricle compression and a midline shift of 7 mm. During her stay in the emergency department while waiting for transfer to the children intensive care unit elsewhere she slightly deteriorated neurologically. Repeat CT scan of the brain 4 h after initial presentation remarkably showed that the subdural hematoma had now largely disappeared, with a decrease in volume and density. Consequently, the mass effect diminished with a near normalization of the midline shift.

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

“…In some cases, neurological condition remained stable [8,10,17,21,28,33] or improved gradually [12,15,16,18,19,24,29,35] The death of one such patient reported by Balik et al had been correlated with hemodynamic instability and sudden cardiac arrest due to sympathetic hyperactivity. On postmortem examination of the above case, redistribution of hematoma in spinal subdural space and ischemic changes in the pons was detected.…”

“…In some cases, neurological condition remained stable[ 8 10 17 21 28 33 ] or improved gradually[ 12 15 16 18 19 24 29 35 ] The death of one such patient reported by Balik et al . had been correlated with hemodynamic instability and sudden cardiac arrest due to sympathetic hyperactivity.…”