gms | German Medical Science

Objective: Although rapid resolution (RR) of acute subdural hematoma (SDH) has rarely been observed, the mechanism is not well understood.

Methods: Here, we present 4 case reports of RR of a large acute SDH with midline shift.

Results: Case 1: A 92-year-old female fell and sustained head trauma. On admission she had a GCS score of 7 points. CT showed a large acute SDH and a thin low density band (TLDB), which implied the involvement of CSF existed in the SDE. A second CT disclosed a RR of SDE 8 h after admission. She was discharged with a moderate left hemiparesis. Case 2: A 88-year-old male suffered head trauma. On admission he had GCS score of 10 points. CT showed a large acute SDH. A TLDB existed in the SDE. A second CT showed a RR of SDE 3h after admission. His condition improved soon. However, he suffered acute renal failure and died 2 weeks later. Case 3: A 67-year-old male suffered head trauma. On admission he had GCS score of 7 points and anisocoria. CT showed a large acute SDH. A TLDB existed in the SDE. A second CT showed a RR of SDE 1h after admission. His condition improved soon. However, he suffered status epilepticus and died 3 days later. Case 4: A 72-year-old male suffered sudden consciousness disturbance. On admission he had GCS score of 5 points and anisocoria. CT showed a large acute SDH. A TLDB existed in the hematoma. A second CT showed a RR of SDE 12h after admission. His condition improved soon. However, he developed chronic SDH and underwent hematoma evacuation 2 weeks later and discharged with no deficits.

Conclusions: It was indicated that a mechanism of RR of acute SDH was attributable to CSF dilution and cerebral atrophy resulting from aging.