RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.4103/ajns.AJNS_380_20
Rapid spontaneous resolution of the acute subdural hematoma: Case series and review of literature
![](https://www.thieme-connect.de/media/10.1055-s-00053244/202101/lookinside/thumbnails/10-4103-ajns-ajns-380-20_309646-1.jpg)
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.
Financial support and sponsorship
Nil.
Publikationsverlauf
Eingereicht: 05. August 2020
Angenommen: 15. Oktober 2020
Artikel online veröffentlicht:
16. August 2022
© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Polman CH, Gijsbers CJ, Heimans JJ, Ponssen H, Valk J. Rapid spontaneous resolution of an acute subdural hematoma. Neurosurgery 1986;19:446-8.
- 2 Shin DW, Choi CY, Lee CH. Spontaneously rapid resolution of acute subdural hemorrhage with severe midline shift. J Korean Neurosurg Soc 2013;54:431-3.
- 3 Makiyama Y. Acute subduaral hematomas spontaneously disappearing within 3 days following closed head injury; report of two cases. Nihon Univ J Med 1985;27:123-7.
- 4 Matsuyama T, Shimomura T, Okumura Y, Sakaki T. Rapid resolution of symptomatic acute subdural hematoma: Case report. Surg Neurol 1997;48:193-6.
- 5 Nagao T, Aoki N, Mizutani H, Kitamura K. Acute subdural hematoma with rapid resolution in infancy: Case report. Neurosurgery 1986;19:465-7.
- 6 Tsui EY, Fai Ma K, Cheung YK, Chan JH, Yuen MK. Rapid spontaneous resolution and redistribution of acute subdural hematoma in a patient with chronic alcoholism: A case report. Eur J Radiol 2000;36:53-7.
- 7 Inamasu J, Nakamura Y, Saito R, Kuroshima Y, Mayanagi K, Ohba S, et al. Rapid resolution of traumatic acute subdural hematoma by redistribution. Am J Emerg Med 2002;20:376-7.
- 8 Kato N, Tsunoda T, Matsumura A, Yanaka K, Nose T. Rapid spontaneous resolution of acute subdural hematoma occurs by redistribution--two case reports. Neurol Med Chir (Tokyo) 2001;41:140-3.
- 9 Kundra SN, Kundra R. Extracranial redistribution causing rapid spontaneous resolution of acute subdural hematoma. Neurol India 2005;53:124.
- 10 Coşar M, Eser O, Aslan A, Ela Y. Rapid resolution of acute subdural hematoma and effects on the size of existent subdural hygroma: A case report. Turk Neurosurg 2007;17:224-7.
- 11 Yadav YR, Agarwal M, Namdev H, Parihar V. Rapid resolution of acute subdural hematoma: A case report and review of literature. Indian J Neurotrauma 2011;8:45-7.
- 12 Watanabe A, Omata T, Kinouchi H. Rapid reduction of acute subdural hematoma and redistribution of hematoma: Case report. Neurol Med Chir (Tokyo) 2010;50:924-7.
- 13 Lee CH, Kang DH, Hwang SH, Park IS, Jung JM, Han JW. Spontaneous rapid reduction of a large acute subdural hematoma. J Korean Med Sci 2009;24:1224-6.
- 14 Balik V, Kolembus P, Svajdler M, Sulla I, Vaverka M, Hrabalek L. A case report of rapid spontaneous redistribution of acute supratentorial subdural hematoma to the entire spinal subdural space presenting as a pourfour du petit syndrome and review of the literature. Clin Neurol Neurosurg 2013;115:849-52.
- 15 Ghadarjani S. Rapid spontaneous resolution of acute cranial subdural hematomas – Two case reports. J Neurol Stroke 2014;1:21-3.
- 16 Gan Q, Zhao H, Zhang H, You C. Rapid spontaneously resolving acute subdural hematoma. J Craniofac Surg 2017;28:e287-9.
- 17 Gelsomino M, Awad AJ, Gerndt C, Nguyen HS, Doan N, Mueller W. Mechanism for the rapid spontaneous resolution of an acute subdural hematoma and transformation into a subdural hygroma. World Neurosurg 2018;115:282-4.
- 18 Koppen H, Arkink E, Nordbeck A, Sie L, van der Gaag N. Swift spontaneous regression of a pediatric traumatic acute subdural hematoma. Case Rep Neurol 2019;11:351-6.
- 19 Bae HJ, Lee SB, Yoo DS, Huh PW, Lee TG, Cho KS. Rapid spontaneous resolution of acute subdural hematoma in a patient with liver cirrhosis. Korean J Neurotrauma 2014;10:134-6.
- 20 Lee IK, Song SW. Spontaneous resolution of acute subdural hematoma with a good clinical outcome: A case report. Nerve 2019;5:83-6.
- 21 Perwez A, Azab W, Singh S. Rapid spontaneous resolution of acute subdural hematoma associated with a contralateral arachnoid cyst: A case report and review of the literature. Int J Students Res 2013;3:26.
- 22 Park JY, Moon KS, Lee JK, Jeung KW. Rapid resolution of acute subdural hematoma in child with severe head injury: A case report. J Med Case Rep 2013;7:67.
- 23 Mirzai H, Yaldiz C, Eminoglu M, Orguc S. Ultra fast resolution of acute post-traumatic subdural haematoma. Neurol Neurosurg Psychiatry 2005;76:1738.
- 24 Chaudhary N, Krivosheya D, Small E, Hsia C, Ng W, Leung A. Rapid resolution of acute subdural hematoma in a coagulopathic patient. Can J Neurol Sci 2013;40:599-600.
- 25 Sato M, Nakano M, Sasanuma J, Asari J, Watanabe K. Rapid resolution of traumatic acute subdural haematoma in the elderly. Br J Neurosurg 2005;19:58-61.
- 26 Liu B, Zhuang Z, Luo J. Fluctuation of intra-parenchymal cerebral pressure may drive the rapid spontaneous resolution of acute subdural hematoma. Med Hypotheses 2013;81:159-62.
- 27 Edwards RJ, Britz GW, Critchley GR. Spontaneous resolution of an acute subdural haematoma. Br J Neurosurg 2002;16:609-10.
- 28 Maqsood A. Rapidly resolving acute subdural hematoma. A case report. Indian J Neurotrauma 2008;05:115-6.
- 29 Kapsalaki EZ, Machinis TG, Robinson JS, Newman B, Grigorian AA, Fountas KN. Spontaneous resolution of acute cranial subdural hematomas. Clin Neurol Neurosurg 2007;109:287-91.
- 30 Choi SH, Park CW, Kim JM, Kim EY, Yoo CJ, Kim YB, et al. Rapid spontaneous resolution of traumatic acute subdural hematoma sung. J Kor Neurotraumatol Soc 2011;7:47-9.
- 31 Berker M, Gulsen S, Ozcan OE. Ultra rapid spontaneous resolution of acute posttraumatic subdural hematomas in patient with temporal linear fracture. Acta Neurochir (Wien) 2003;145:715-7.
- 32 Ozay R, Fesli R, Balkan S, Turkoglu E, Sekerci Z. Rapid resolution of an acute subdural hematoma in Dandy Walker syndrome. Neurol India 2015;63:286.
- 33 Öğrenci A, Ekşi MŞ, Koban O, Karakuş M. Spontaneous rapid resolution of acute subdural hematoma in children. Childs Nerv Syst 2015;31:2239-43.
- 34 Byrappa V, Bansal S, Kamath S, Kadarapura GK. Spontaneous resolution of traumatic acute subdural hematoma with good clinical outcome: A report of two cases. Indian J Neurotrauma 2014;11:146-9.
- 35 Hostettler IC, Murahari S, Raza MH, Kontojannis V, Tsang K, Kareem H, et al. Case report on the spontaneous resolution of a traumatic intracranial acute subdural haematoma: Evaluation of the guidelines. Acta Neurochir (Wien) 2018;160:1311-4.
- 36 Dang RS, Panwar DS, Sharma R, Singh SC. Spontaneous resolution of acute subdural hematoma. J Evol Med Dent Sci 2011;2:8841-4.
- 37 Wen L, Liu WG, Ma L, Zhan RY, Li G, Yang XF. Spontaneous rapid resolution of acute subdural hematoma after head trauma: Is it truly rare? Case report and relevant review of the literature. Ir J Med Sci 2009;178:367-71.
- 38 Yamashima T, Friede RL. Why do bridging veins rupture into the virtual subdural space? J Neurol Neurosurg Psychiatry 1984;47:121-7.
- 39 Miller JD, Nader R. Acute subdural hematoma from bridging vein rupture: A potential mechanism for growth: Clinical article. J Neurosurg 2014;120:1378-84.
- 40 Kuroiwa T, Tanabe H, Takatsuka H, Arai M, Sakai N, Nagasawa S, et al. Rapid spontaneous resolution of acute extradural and subdural hematomas. Case Rep J Neurosurg 1993;78:126-8.
- 41 Wong ST, Yuen MK, Fok KF, Yuen SC, Yam KY, Fong D. Redistribution of hematoma to spinal subdural space as a mechanism for the rapid spontaneous resolution of posttraumatic intracranial acute subdural hematoma: Case report. Surg Neurol 2009;71:99-102.
- 42 Marmarou A, Shulman K, Rosende RM. A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurg 1978;48:332-44.
- 43 Wagshul ME, Eide PK, Madsen JR. The pulsating brain: A review of experimental and clinical studies of intracranial pulsatility. Fluids Barriers CNS 2011;8:5.
- 44 Suzuki Y, Kawamata T, Matsumoto H, Kunii N, Matsumoto K. A resolving sign of acute subdural hematoma: From report of two cases. No Shinkei Geka 1998;26:1025-29.
- 45 Rennels ML, Gregory TF, Blaumanis OR, Fujimoto K, Grady PA. Evidence for a 'paravascular' fluid circulation in the mammalian central nervous system, provided by the rapid distribution of tracer protein throughout the brain from the subarachnoid space. Brain Res 1985;326:47-63.
- 46 Orešković D, Klarica M. A new look at cerebrospinal fluid movement. Fluids Barriers CNS 2014;11:16.
- 47 Cohen JE, Eger K, Montero A, Israel Z. Rapid spontaneous resolution of acute subdural hematoma and HIV related cerebral atrophy: Case report. Surg Neurol 1998;50:241-4.