J Korean Neurosurg Soc.  2015 Sep;58(3):301-303. 10.3340/jkns.2015.58.3.301.

Spontaneous Resolution of a Large Chronic Subdural Hematoma Which Required Surgical Decompression

• Lee GS
• Park YS
• Min KS
• Lee MS

• KMID: 2191389
• DOI: http://doi.org/10.3340/jkns.2015.58.3.301

Abstract

We report on a case of an 87-year-old woman who showed spontaneous resolution of a large chronic subdural hematoma which required surgical decompression. She had suffered from confused mentality and right side weakness of motor grade II for 10 days. The initial brain CT scan showed a 22 mm thick low density lesion located in the left fronto-temporo-parietal region with midline shift (12 mm) which required emergency decompression. However, because she and her family did not want surgery, she was followed up in the outpatient clinic. Five months later, follow up brain CT showed that the CSDH had disappeared and the patient became neurologically normal. The reasons for spontaneous resolution of CSDH remain unclear. We discuss the possible relation between mechanisms of physio-pathogenesis and spontaneous resolution of a large chronic subdural hematoma (CSH) in an elderly patient.

Keyword

Chronic subdural hematoma; Craniotomy; Burr hole; Observation

MeSH Terms

Aged
Aged, 80 and over
Ambulatory Care Facilities
Brain
Craniotomy
Decompression
Decompression, Surgical*
Emergencies
Female
Follow-Up Studies
Hematoma, Subdural, Chronic*
Humans
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 A : Initial brain CT scans showed thick crescent low density lesions in left fronto-temporo-parietal regions with midline shift. B : Follow-up CT scan 1 month later showed a decreased amount of subdural hematoma. C and D : Follow-up CT scan 2 and 3 months later showed gradual resolution of the hematoma. E : Follow-up CT scan 5 months later showed disappearance of the hematoma.

Reference

1. Glover D, Labadie EL. Physiopathogenesis of subdural hematomas. Part 2 : Inhibition of growth of experimental hematomas with dexamethasone. J Neurosurg. 1976; 45:393–397. PMID: 956875.

2. Göksu E, Akyüz M, Uçar T, Kazan S. Spontaneous resolution of a large chronic subdural hematoma : a case report and review of the literature. Ulus Travma Acil Cerrahi Derg. 2009; 15:95–98. PMID: 19130348.

3. Hohenstein A, Erber R, Schilling L, Weigel R. Increased mRNA expression of VEGF within the hematoma and imbalance of angiopoietin-1 and -2 mRNA within the neomembranes of chronic subdural hematoma. J Neurotrauma. 2005; 22:518–528. PMID: 15892598.

4. Horikoshi T, Naganuma H, Fukasawa I, Uchida M, Nukui H. Computed tomography characteristics suggestive of spontaneous resolution of chronic subdural hematoma. Neurol Med Chir (Tokyo). 1998; 38:527–532. discussion 532-533PMID: 9805896.

5. Kageyama H, Toyooka T, Tsuzuki N, Oka K. Nonsurgical treatment of chronic subdural hematoma with tranexamic acid. J Neurosurg. 2013; 119:332–337. PMID: 23641825.

6. Kawano N, Suzuki K. Presence of smooth-muscle cells in the subdural neomembrane. J Neurosurg. 1981; 54:646–651. PMID: 7229703.

7. Nakamura N, Ogawa T, Hashimoto T, Yuki K, Kobayashi S. Reevaluation on resolving subdural hematoma [(author's transl)]. Neurol Med Chir (Tokyo). 1981; 21:491–500. PMID: 6168960.

8. Nomura S, Kashiwagi S, Fujisawa H, Ito H, Nakamura K. Characterization of local hyperfibrinolysis in chronic subdural hematomas by SDS-PAGE and immunoblot. J Neurosurg. 1994; 81:910–913. PMID: 7965121.

9. Park CK, Choi KH, Kim MC, Kang JK, Choi CR. Spontaneous evolution of posttraumatic subdural hygroma into chronic subdural haematoma. Acta Neurochir (Wien). 1994; 127:41–47. PMID: 7942180.

10. Parlato C, Guarracino A, Moraci A. Spontaneous resolution of chronic subdural hematoma. Surg Neurol. 2000; 53:312–315. discussion 315-317PMID: 10825513.

11. Santarius T, Kirkpatrick PJ, Kolias AG, Hutchinson PJ. Working toward rational and evidence-based treatment of chronic subdural hematoma. Clin Neurosurg. 2010; 57:112–122. PMID: 21280503.