Spontaneous Resolution of Acute Subdural Haematoma

Abstract

ABSTRACT:We report a case of a 47 year old man who presented with head injury due to road traffic accident, with CT scan suggestive of large left sided acute SDH with comminuted fracture of occipital bone. Within a few hours, patient showed significant neurological improvement. Follow-up CT scan revealed rapid spontaneous resolution and redistribution of the acute SDH. The proposed hypothesis explaining this rare phenomenon suggests intracranial and extra cranial redistribution as the cause of spontaneous resolution of acute SDH. The intracranial phenomenon is more common of the two. To our knowledge, this is the first case in the literature where both intracranial and extracranial phenomenon played a role in the same patient leading to rapid spontaneous resolution of acute SDH. KEY WORDS: • acute subdural hematoma • spontaneous resolution • intracranial redistribution • extracranial redistribution. INTRODUCTION:Acute subdural hematoma (SDH) is a common entity after traumatic brain injury. 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. (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. The possibility of spontaneous resolution of an acute SDH, although remote, may affect the decision making process regarding the management of these patients under certain conditions 1 .

Rapid spontaneous resolution of the acute subdural hematoma: Case series and review of 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.…”

“…Redistribution site Addition factor Dang RS [36] [35] 88 years/ male GCS14 Gradual 34.6 h 18 mm + Mixed density of clot Wen L [37] 22 years/ male GCS11 + 5 h Thick + Hypo between inner table and clot+mixed density clot Inamasu J [7] 16 years/ male E1M6V2 + 2 h Thick + Mixed density of clot Tentorium † Neurological status -1 st recorded neurological status after trauma; ^Rapid neurological improvement -improvement in neurological status in<24 h; # Gradual -improvement in neurological status after 24 h; *Interval time -time for radiological findings of clot reduction or resolution since trauma; $Thickness of SDH -thickness of subdural hematoma on patient 1 st CT scan head; # CT scan finding -findings of 1 st CT scan head after trauma. GCS -Glasgow coma scale; JCS -Japan coma scale; SAS -Subarachnoid space; SDH -Subdural hematoma; CT -Computed tomography; NA -Not available Table 3: Contd... rapid resolution of ASDH.…”