Resolution Of Acute Subdural Hematoma Research Articles

Spontaneous Resolution of Acute Subdural Hematoma in a Patient with Thrombocytopenia: A Blessing in Disguise

AbstractAcute subdural hematoma (SDH) constitutes one of the most common emergencies in neurosurgery and its spontaneous resolution is an uncommon phenomenon. Several theories have been described to explain this phenomenon including redistribution of subdural blood, dilution by cerebrospinal fluid, and brain atrophy. Rapid resolution of acute SDH related to thrombocytopenia is a rare phenomenon. We report a case of a patient who showed rapid resolution of acute SDH with thrombocytopenia and also discuss such a rare case with speculation of the thrombocytopenia as a factor to promote this phenomenon.

Spontaneous and rapid resolution of acute subdural hematoma in a 5-year-old child: A case report

Abstract Subdural hematoma (SDH) following trauma is a common neurosurgical emergency but rapid and spontaneous resolution of the same is a rare phenomenon. Authors report a case of 5-year-old female child in whom spontaneous and rapid resolution of acute SDH was observed. The hematoma spontaneously resolved over a period of only 5 h. Only a handful of case reports exist on this phenomenon and various causes for rapid resolution have been reported to be dilution by cerebrospinal fluid and redistribution of hematoma. A hypodensity inside the hematoma along with improvement in neurological condition of the patient can point to the correct diagnosis. This case report is useful in making the neurosurgeon cognizant of this entity and make timely informed decisions based on radiology and clinical examination. Being forewarned is being forearmed.

Spontaneous Rapid Resolution of Acute Subdural Hematoma: Revelation in the Era of Modern Science

AbstractAcute subdural hematoma (SDH) with mass effect and midline shift is an indication for emergency surgery in neurotrauma. A very few case reports were present in the literature showing rapid resolution of acute SDH with improvement in clinical condition of the patient within hours after trauma. In this article, we presented a case of acute SDH that showed almost disappearance of hematoma within 5 hours after trauma.

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

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

Spontaneous Resolution of Acute Subdural Hematoma in Young Adult with Significant Head Injury: A Case Report

Spontaneous Resolution of Acute Subdural Hematoma in Young Adult with Significant Head Injury: A Case Report

Complete resolution of acute subdural hematoma in an elderly patient with the subdural evacuating port system

A 79-year-old patient on an antiplatelet medication presented to the emergency department following a fall at home. She was found to have an enlarging mixed density acute subdural hematoma with significant mass effect and impaired neurologic status and was successfully treated with a subdural evacuating port system drain placement. The patient had rapid and complete radiographic resolution of the hematoma and return to her premorbid neurologic status. A craniotomy, and the associated risks, was avoided. Elderly patients are at particular risk for developing subdural hematomas given the high rates of receiving antiplatelet and anticoagulation therapies, risk for falls, and difficulties with safe ambulation and independent living. Twist drill craniostomy drainage through catheter or subdural evacuating port system placement has been used effectively in the treatment of liquefied older chronic or subacute subdural hematomas. However, acute subdural hematomas, when large or symptomatic enough to require evacuation have historically been treated by craniotomy. Craniotomy in elderly patients with a subdural hematoma has significant risks and typically requires several days of hospitalization and intensive care, which was avoided in this patient. Subdural evacuating port system drain placement can be an effective treatment option in some elderly patients with acute subdural hematomas, which have a significant hypodense component.

The clinical and CT features of rapid spontaneous resolution of traumatic acute subdural hematoma: A retrospective study of 14 cases

Objective: Resolution of a traumatic acute subdural haematoma (ASDH) requires weeks or months. However, cases of rapid spontaneous resolution of ASDH within 72 hours after trauma have been reported. The purpose of this study was to obtain a better understanding of the clinical and CT features of cases of rapid resolution following traumatic ASDH.Method: Between 2011–2014, the authors retrospectively collected data from 14 patients with rapid resolution of traumatic ASDH. The clinical data and CT findings of these cases were collected and analysed.Results: In 13 of the 14 patients, there was a rapid spontaneous resolution of the ASDH within 48 hours. The mean haematoma width of the second CT was significantly smaller than the width of the initial CT. A significantly marked resolution of the midline shift was observed in the second CT in all patients. The outcome was good in the majority of patients.Conclusions: The acute fluctuation of ICP may drive the spontaneous rapid resolution and redistribution of ASDH. Patients with abnormal coagulant function may be more likely to experience rapid resolution of ASDH. A band of low density in the initial CT image may be a useful sign for rapid resolution of ASDH.

Predictors of rapid spontaneous resolution of acute subdural hematoma

ObjectiveAcute subdural hematoma (ASDH) usually requires emergency surgical decompression, but rare cases exhibit rapid spontaneous resolution. The aim of this retrospective study was to identify factors predictive of spontaneous ASDH resolution. MethodsA total of 366 consecutive patients with ASDH treated between January 2006 and September 2012 were identified in our hospital database. Patients with ASDH clot thickness >10mm in the frontoparietotemporal region and showing a midline shift >10mm on the initial computed tomography (CT) scan were divided into two groups according to subsequent spontaneous resolution. Univariate and multivariate logistic regression analyses were used to identify factors predictive of rapid spontaneous ASDH resolution. ResultsFifty-six ASDH patients met study criteria and 18 demonstrated rapid spontaneous resolution (32%). Majority of these patients were not operated because of poor prognosis/condition and in accordance to family wishes. Univariate analysis revealed significant differences in use of antiplatelet agents before head injury and in the incidence of a low-density band between the hematoma and inner wall of the skull bone on the initial CT. Use of antiplatelet agents before head injury (OR 19.6, 95% CI 1.5–260.1, p=0.02) and the low-density band on CT images (OR 40.3, 95% CI 3.1–520.2, p=0.005) were identified as independent predictive factors by multivariate analysis. ConclusionsOur analysis suggested that use of antiplatelet agents before head injury and a low-density band between the hematoma and inner skull bone on CT images (indicative of cerebrospinal fluid infusion into the subdural space) increase the probability of rapid spontaneous resolution.

Rapid Resolution of Acute Subdural Hematoma in a Coagulopathic Patient

Rapid Resolution of Acute Subdural Hematoma in a Coagulopathic Patient

Fluctuation of intra-parenchymal cerebral pressure may drive the rapid spontaneous resolution of acute subdural hematoma

Acute subdural hematoma (ASDH) is a severe insult with a high mortality rate, and emergent surgical evacuation is recommended in the vast majority of such cases. Generally, resolution of the hemorrhage requires weeks and months in patients treated conservatively. However, numerous cases of rapid spontaneous resolution of ASDH, occurring within 72h after the trauma, have been reported to date in the literature. Several possible hypotheses have been suggested, primarily involving redistribution and dilution, or washing out the ASDH. In this study, we present the relevant images of such a case, review the mechanisms of the rapid spontaneous resolution in the literature, and also propose a new hypothesis to explain the occurrence of the rapid spontaneous resolution of ASDH. We indicate that the fluctuation of intra-parenchymal cerebral pressure that drives the rapid spontaneous resolution of ASDH.

Rapid resolution of acute subdural hematoma in child with severe head injury: a case report

IntroductionRapid spontaneous resolution of traumatic acute subdural hematoma is an infrequent phenomenon and mainly develops in a case of simple acute subdural hematoma without parenchymal contusion. However, it has been rarely reported in a pediatric case with severe initial head injury.Case presentationA 7-year-old Asian girl with traumatic acute subdural hematoma was transferred to our hospital for an emergency operation based on the results of an initial computed tomography scan and neurological examination. However, a repeat computed tomography scan two hours after trauma disclosed considerable reduction of the hematoma and midline shift with neurological improvements. Serial follow-up imaging studies demonstrated apparent redistribution of the hematoma over the cerebellar tentorium, posterior interhemispheric fissure and subarachnoid space. The patient was discharged with mild confusion 40 days after the admission.ConclusionA follow-up computed tomography scan is strongly recommended before surgery when a child with a severe head injury presents with any sign of neurological improvement, especially with a mixed density hematoma on the initial computed tomography scan.

Rapid spontaneous resolution of acute subdural hematoma associated with a contralateral arachnoid cyst: A case report and review of the literature

Rapid resolution of post-traumatic acute subdural hematoma is infrequently reported. We report a case of rapid spontaneous disappearance of post-traumatic acute subdural hematoma in one patient who was discovered to have a contralateral middle cranial fossa arachnoid cyst. The previously reported mechanisms responsible for the rapid spontaneous disappearance of post-traumatic acute subdural hematoma are reviewed and the contribution of the middle cranial fossa arachnoid cyst to the disappearance of the pos-traumatic acute subdural hematoma that has taken place in our case is discussed. To the best of our knowledge the association between spontaneous disappearance of post-traumatic acute subdural hematoma and arachnoid cysts has not been previously reported.

Rapid resolution of acute subdural hematoma: A case report and review of literature

Acute traumatic subdural hematoma is a common condition. Cases of rapid resolution of acute subdural hematoma have seldom been reported in the literature. We are reporting one such case of 53 year-old-male admitted after road traffic accident. Patient became unconscious immediately after the accident. Computed Tomography (CT) done after one hour of accident showed an acute hyperdense subdural hematoma with low density area between skull and hematoma and subarachnoid hemorrhage (SAH). He improved quite rapidly during transportation and became conscious at the time of admission in our hospital. Repeat CT scan done after 7 hours showed marked resolution of hematoma but there was evidence of subarachnoid hemorrhage (SAH). Another CT scan done after 72 hours of injury showed complete resolution of hematoma with evidence of SAH. Possible mechanism of spontaneous resolution of the hematoma in our case was dilution and washing-out of hematoma by the cerebrospinal fluid due to an arachnoid tear. Clinician should suspect possibility of resolving hematoma if CT scan shows presence of SAH and hypodensity between hematoma and skull. Such patients who do not deteriorate while awaiting surgery because of delay due to any reason should get a repeat CT scan before planning any surgical intervention.

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

Spontaneous rapid resolution of acute subdural hematoma (ASDH) is a rare phenomenon for this severe insult after head trauma. We present a 22-year-old patient who developed ASDH with a moderate midline shift and compression of lateral ventricle after a truncal collision but without a direct beat on the head. Conservative management was performed under close monitoring because of unexpected improvement of clinical signs and symptoms. Unexpectedly, the ASDH resolved spontaneously within 13 h after the trauma, and he was discharged 1 week later without any neurological deficit. In addition, similar cases reported in literature were reviewed. Because most of the patients developing ASDH underwent emergent surgical intervention, the incidence of this phenomenon may be underestimated. Although emergent surgical removal remains the first choice for the treatment of ASDH, conservative management with careful monitoring may also work out in selected patients who show neurologic and radiologic improvements.

Extracranial redistribution causing rapid spontaneous resolution of acute subdural hematoma

Extracranial redistribution causing rapid spontaneous resolution of acute subdural hematoma

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

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.

Resolución precoz espontánea de hematoma subdural agudo intracraneal

Acute subdural hematomas are usually neurosurgical emergencies, although a conservative therapy is indicated in selected cases. In some of these patients a progressive resolution is appreciated. However, rapid spontaneous resolution of an acute suddural hematoma is seldom reported. A patient with antecedent of chronic alcoholism and spontaneous resolution of acute subdural hematoma in less than 18 hours after the head injury is described. The possible mechanisms of this rapid resolution are discussed. A tear in the arachnoid with spilling of CSF into the subdural space and the effect of intracranial antihypertensive measures together with cerebral atrophy, are factors that possibly contribute to dilution and redistribution of blood with hematoma disappearing in CT scan.

Rapid spontaneous resolution of acute subdural hematoma and HIV related cerebral atrophy: case report

BACKGROUND The natural history of a traumatic acute subdural hematoma is usually interrupted by its prompt surgical removal. Rapid spontaneous resolution within 48 hours, although infrequently reported, may be, underestimated and demonstrates a benign course of this condition. To our knowledge, this is the first case of rapid spontaneous resolution of an acute subdural hematoma in a patient with HIV encephalopathy and cerebral atrophy. METHODS AND RESULTS This 27-year-old man, an intravenous drug user with AIDS-related complex and HIV encephalopathy, suffered an acute subdural hematoma due to head injury in a car accident. The hematoma spontaneously resolved within 12 hours, resulting in a favorable outcome with nonoperative treatment. CONCLUSIONS AIDS related cerebral atrophy may not only have predisposed the patient to the development of an extracerebral collection, but may have also favorably influenced the spontaneous resolution of the hematoma. The mechanism of the hematoma resolution and the influence of HIV related cerebral atrophy is discussed.

Rapid resolution of symptomatic acute subdural hematoma: Case report

Only a few cases showing spontaneous resolution of acute subdural hematoma (ASDH) have been reported. Several possible mechanisms of spontaneous resolution of ASDH have been reported. Two possible hypotheses have been suggested: (1) the hematoma is diluted by cerebrospinal fluid (CSF) due to tearing of the arachnoid membrane and is washed out, (2) the hematoma is compressed by the pressure produced by acute brain swelling and redistributed. In this article, we report a patient with a rapid spontaneous resolution of an ASDH and discuss the mechanisms. We experienced a case of a spontaneous resolution of symptomatic ASDH within only 3 hours. Characteristic serial changes on computed tomography (CT) corresponding to neurologic changes were obtained. Serial CT findings showing changes corresponding to neurologic fluctuation were obtained. The characteristic features of the CT findings are as follows: (1) participation of CSF at the lateral portion of the hematoma was recognized during the early period after injury, (2) no cerebral contusion was identified, (3) acute cerebral swelling was not identified, (4) when the neurologic state deteriorated, the hematoma had not enlarged, but there was an increase in the low-density area corresponding to participation of the CSF and midline shift was recognized. Spontaneous resolution of ASDH depends on both dilution due to CSF participation and redistribution of the blood; but acute cerebral swelling is not a necessary condition. Elasticity of the brain and absence of cerebral contusion obstructing the outflow of the cerebrospinal fluid is optimal.

P-2-169 - Rapid resolution of acute subdural hematoma. Case report

P-2-169 - Rapid resolution of acute subdural hematoma. Case report