Rapid Spontaneous Resolution of Signs of Intracranial Herniation Due to Subdural Hematoma. Case Report.

Abstract

An 83-year-old female presented with signs of intracranial herniation due to subdural hematoma (SDH) which resolved rapidly and spontaneously. This patient showed bilateral decerebrate postures due to left SDH on admission. Since she had serious neurological symptoms and critical systemic conditions caused by an asthma attack, conservative treatment including osmotherapy and mechanical ventilation was performed instead of surgical intervention. Her signs of intracranial herniation resolved only 6 hours after admission. Although the SDH did not diminish rapidly, she showed excellent neurological improvement even with conservative treatment only. Characteristic serial changes on computed tomography corresponding to the neurological improvements were seen. She was discharged with slight right hemiparesis and slight dementia that were present prior to this admission. The rapid resolution of signs of intracranial herniation was attributable to the spontaneous diminution of SDH. The diminution or disappearance of hematomas probably depended on the redistribution of cerebrospinal fluid into the hematoma in the present case.

Spontaneous rapid resolution of acute subdural hematoma after head trauma: Is it truly rare?

“…Rapid resolution of ASDH is considered as a rare phenomenon in the ASDH, and we collected the 19 cases reported in previous literature who had experienced this phenomenon following head trauma. The information about these cases reported is shown in Table 1 [1][2][3][4][5][6][7][8][9][10][11][12][13]. An analysis of these cases was performed as well and the outcome was shown in Table 2.…”

Rapid Spontaneous Resolution of Neurological Signs and Cerebral Herniation Caused by Intracerebral Hemorrhage -Case Report-

“…2,[6][7][8]11) For example, hematoma resolution has been attributed to intracranial redistribution and washing out by cerebrospinal fluid (CSF) through a torn arachnoid membrane. 2,[6][7][8]11) Although this mechanism has not been proposed, the same pathophysiology may underlie the rapid resolution of intracerebral hemorrhage. Our patient presented with a subcortical hematoma with a margin very close to the subarachnoid space.…”

“…2,[6][7][8]11) CSF liquidizes the hematoma and the blood clots are redistributed to the subarachnoid and subdural spaces. 7) In addition, our patient had a history of liver cirrhosis, so coagulopathy may have enhanced the mobility of the hematoma.…”

Spontaneous Resolution of Acute Subdural Haematoma

“…Acute SDH, more than 10mm in thickness, require immediate surgical evacuation in vast majority of the cases. Though a very rare phenomenon, rapid spontaneous resolution of acute SDH does occur 1,2,3,4,5,6,7 . Two possible hypotheses have been suggested: (1) the hematoma is diluted by cerebrospinal fluid (CSF) due to tearing of the arachnoid membrane and then is washed out.…”

“…Two possible hypotheses have been suggested: (1) the hematoma is diluted by cerebrospinal fluid (CSF) due to tearing of the arachnoid membrane and then is washed out. (2) The hematoma is compressed by the pressure produced by acute brain swelling and is redistributed 4 . In our current communication, we present a case of spontaneous resolution of acute SDH, the proposed theories explaining spontaneous resolution of acute SDH, as well as, the clinical parameters and imaging characteristics that might predict such a phenomenon are also reviewed.…”