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

Abstract

Background: Traumatic acute subdural hematoma (ASDH) is an oft encountered entity in neurosurgery. While resolution of such thick SDHs usually takes time, certain cases of rapid spontaneous resolution have also been reported. This article attempts to review the pathophysiology, clinical and radiological features of such cases, as well as provide an insight into decision making for their management. Methods: Electronic literature search was done to look for similar cases of spontaneous rapid resolution of ASDH. Five of authors cases have been described. Their clinical and radiological features along with those of cases from literature search were tabulated and analyzed. Results: A total of 44 relevant cases were included for analyses. Of these, 39 cases were from 33 articles found in existing literature and 5 cases were from author's collection. The M:F ratio was 25:19 with a mean age was 41.84(SD-4.094) years. Twenty -six patients showed “Rapid” neurological improvement (</= 24 hours) while “gradual” neurological improvement (>24 hours) occurred in 10 patients. The mean hematoma resolution time on CT scan was 13.78 hours (SD 16.46) ranging from 1- 72 hours. Twenty-nine patients showed redistribution of hematoma, most commonly to tentorium and falx cerebelli. CT scan findings were classified into 5 types as per the nature of hypodensity around hematoma. The geometric mean time to resolution of hematoma was least for type 2 (7.27 hours) and type 1(7.52 hours) patients. Conclusion: Selected patients of ASDH with rapid neurological improvement and specific CT findings may show spontaneous resolution of ASDH. Multicentric studies with larger study population may provide better insight into the nature and outcomes of such entities.

Microvascular proliferation in the clots: The key finding of acute subdural hematoma transforming into chronic subdural hematoma?

“…Spontaneous resolution in a short period is known to be an infrequent but distinct phenomenon of ASDH, which is represented by dissemination and redistribution of the subdural hematoma. [10] In addition, the period for the transformation of the ASDH into the symptomatic CSDH in our case was consistent with that seen in previous study. [5] Although not evident on neuroimages, intraoperative and histological findings showed that the nodular lesion presented microvascular proliferation, typically a characteristic finding of the outer membrane of CSDHs, indicating production of hematoma fluid.…”

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.…”

“…In their review, radiological findings of resolution of ASDH or clot reduction started at 1 hour after trauma. 12) …”

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

Nonepileptic, Stereotypical, and Intermittent Symptoms After Subdural Hematoma Evacuation

“…Of all head traumas from mild to severe, an average of 11% is complicated by an acute SDH [ 4 , 6 ]. Patients with an acute SDH present with symptoms ranging from their neurological baselines to varying levels of consciousness to coma [ 7 ]. Interestingly, focal deficits may be ipsilateral or contralateral to the side of the SDH [ 8 ].…”