J Neurocrit Care.  2018 Dec;11(2):119-123. 10.18700/jnc.180051.

Rapid Spontaneous Resolution of Contralateral Acute Subdural Hemorrhage Caused by Overdrainage of Chronic Subdural Hemorrhage

• Yoo M
• Kim JS

• KMID: 2434838
• DOI: http://doi.org/10.18700/jnc.180051

Abstract

BACKGROUND
Since the first report of a rapidly resolved subdural hemorrhage (SDH) in 1986, few additional case reports have been presented in the literature.
CASE REPORT
An 82-year-old female patient presented with a SDH over the left convexity. The SDH was removed via catheter drainage through a burr hole trephination. Post-operative computed tomography (CT) following 300 mL drainage from the chronic SDH demonstrated a newly developed SDH along the right convexity. A follow-up CT performed 2 hours later revealed an unexpected significant resolution of the acute SDH.
CONCLUSION
The spontaneous resolution of acute SDH is believed to result from redistribution by washout of the hematoma by cerebrospinal fluid dilution. However, its exact pathophysiology is not well understood. When surgical evacuation is considered in acute SDH, conservative management should also be considered because spontaneous resolution of hemorrhage remains a possibility.

Keyword

Hematoma; Hematoma, Subdural; Hematoma, Subdural, Chronic

MeSH Terms

Aged, 80 and over
Catheters
Cerebrospinal Fluid
Drainage
Female
Follow-Up Studies
Hematoma
Hematoma, Subdural*
Hematoma, Subdural, Chronic
Hemorrhage
Humans
Trephining

Figure

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  Figure 1. (A) Non-contrast computed tomography demonstrated a SDH over the left convexity. (B) Gradient-echo and (C) T2-weighted images revealing a SDH in the left convexity. (D) Post-operative computed tomography following drainage of the left hematoma, demonstrating a newly developed subdural hemorrhage along the right convexity. SDH, subdural hemorrhage.

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  Figure 2. (A) A follow-up CT performed 2 hours later revealed spontaneous resolution of the hemorrhage, and a hyperdense band consistent with bleeding (black arrow), in addition to a layered hypodense component consistent with cerebrospinal fluid (white arrow). (B) A CT performed post-operatively on day 2 revealed a further diminished hemorrhage. (C) A CT performed post-operatively on day 4 revealed a further decreased hemorrhage at the right convexity. (D) A CT performed post-operatively on day 7 revealed little hemorrhages at the right convexity. CT, computed tomography.

Reference

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