Ultra rapid spontaneous resolution of acute posttraumatic subdural hematomas in patient with temporal linear fracture

Abstract

We report a case of 57 year-old man with documented posttraumatic acute subdural hematoma and a linear temporal bone fracture. He suffered from a blunt head injury and presented with sudden loss of consciousness. Within 2 hours he became alert and oriented. Follow-up CT scan of brain 2 hours after the initial one showed resolution and redistribution of the subdural hematoma. To our knowledge, this is the first case in the literature about spontaneous resolution of an acute subdural hematoma in a patient with a linear fracture and the fastest resolution period. In this article, the authors discuss the underlying pathophysiology of this uncommon phenomenon.

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 Reduction of Acute Subdural Hematoma and Redistribution of Hematoma -Case Report-

“…7) Brain swelling may be important in the redistribution of hematoma in young patients. 9) In the present case, compression and redistribution of the relatively thin hematoma by acute brain swelling, 8,11,13,17) redistribution of the hematoma through a skull fracture, 2,10,12,21) redistribution of the hematoma to the spinal subdural space, 3,20) and dilution and washing out of the hematoma by CSF after tearing of the arachnoid membrane 13,15,18) are all possible mechanisms for the spontaneous resolution of the ASDH, but were not considered to be the main mechanism for rapid reduction of ASDH.…”

“…1,5,13,14,16,19) Four mechanisms for this rapid resolution of hematoma have been proposed: Dilution and wash out of the hematoma by cerebrospinal fluid (CSF) after tearing of the arachnoid membrane 13,15,18) ; compression and redistribution of the hematoma by acute brain swelling 8,11,13,17) ; redistribution of the hematoma through skull fractures 2,10,12,21) ; and redistribution of the hematoma to the spinal subdural space. 3,20) Here we report a case of rapid spontaneous reduction of ASDH due to redistribution of hematoma, mainly to the supratentorial subdural space because of the brain atrophy.…”

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.…”