Spontaneous resolution of large acute subdural hematoma and the value of neurological exam in conservative management of high risk patients

Very Rapid Resolution of Posttraumatic Acute Subdural Hematoma in a 2-Year-Old Girl: A Case Report

“…The mechanism of the PTASDH resolution has been attributed to intracranial redistribution of the hematoma rather than disappearance in the subdural space. Also, washing out of the hematoma by cerebrospinal fluid through the torn arachnoid membrane has been proposed by Nagao et al 2 A similar phenomenon has also been reported by Matsuyama et al and was believed to be due to cerebrospinal fluid dilution in the subdural space. 2 Aoki emphasized the potential for communication between intracranial and epicranial hematoma through a fracture.…”

“…Also, washing out of the hematoma by cerebrospinal fluid through the torn arachnoid membrane has been proposed by Nagao et al 2 A similar phenomenon has also been reported by Matsuyama et al and was believed to be due to cerebrospinal fluid dilution in the subdural space. 2 Aoki emphasized the potential for communication between intracranial and epicranial hematoma through a fracture. 2 Cerebral atrophy may facilitate accommodation and redistribution of ASDH.…”

“…2 They propose that fluctuation of intraparenchymal cerebral pressure related to agitation or vomiting acts as a piston to redistribute the ASDH. 2 In our report, this patient had a linear right frontal bone fracture with P TA SDH. The linear fracture might have facilitated the redistribution of the ASDH and improvement of the brain shift.…”

“…2 Aoki emphasized the potential for communication between intracranial and epicranial hematoma through a fracture. 2 Cerebral atrophy may facilitate accommodation and redistribution of ASDH. Liu et al discussed these hypotheses and also proposed what they call the "Piston theory."…”

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

“…Since ASDH with severe mass effect and neurologic symptoms almost always undergo immediate decompressive surgery, the observation of its natural clinical course is restricted to patients chosen for conservative treatment. There have been reported cases where the rapid resolution of ASDH showing neurological improvements with conservative treatment [1][2][3]5,8,10,12,14,15,17,[19][20][21][22] .…”