Korean J Neurotrauma.  2018 Apr;14(1):24-27. 10.13004/kjnt.2018.14.1.24.

Development of Delayed Acute Subdural Hematoma after Mild Traumatic Brain Injury: A Case Report

• Hong SO
• Kang DS
• Kong MH
• Jang SY
• Kim JH
• Song KY

• KMID: 2410917
• DOI: http://doi.org/10.13004/kjnt.2018.14.1.24

Abstract

We report a case involving the development of a delayed acute subdural hematoma (ASDH) after trauma, with the absence of any abnormal radiological and clinical findings at initial examination. A 54-year-old male visited the emergency department after a minor trauma. The patient only complained of mild headache after head injury. He presented no abnormal findings on neurological examination, and brain computed tomography (CT) did not show any intracranial lesion or skull fractures. However, he developed seizure with disorientation eight hours after trauma, and ASDH with midline shift was found during a follow-up CT. He recovered without neurological deficits after immediate primary care and admission to the neurosurgery department. On serial follow-up CT images, a gradually increasing mass effect of hematoma was detected, and removed by craniotomy. The patient recovered without neurologic deficits.

Keyword

Acute subdural hematoma; Surgical decompression; Traumatic brain injury

MeSH Terms

Brain
Brain Injuries*
Craniocerebral Trauma
Craniotomy
Decompression, Surgical
Emergency Service, Hospital
Follow-Up Studies
Headache
Hematoma
Hematoma, Subdural, Acute*
Humans
Male
Middle Aged
Neurologic Examination
Neurologic Manifestations
Neurosurgery
Primary Health Care
Seizures
Skull Fractures

Figure

• 

  FIGURE 1 (A) Initial computed tomography (CT) shows no abnormalities. (B) Follow-up CT shows acute subdural hematoma on left cerebral convexity on 8 hours after trauma.

• 

  FIGURE 2 (A) Computed tomography scan disclose increasing mass effect of hematoma and midline shift of approximately 10 mm. (B) Diffusion weighted magnetic resonance image shows mixed density of delayed acute subdural hematoma.

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  FIGURE 3 (A) Postoperative computed tomography (CT) after hematoma evacuation shows the recovered midline. (B) CT reveals recurrent acute subdural hematoma on 3rd postoperative day (C) CT scan shows no additional hematoma or other abnormal findings at discharge.

Reference

1. Diaz FG, Yock DH Jr, Larson D, Rockswold GL. Early diagnosis of delayed posttraumatic intracerebral hematomas. J Neurosurg. 1979; 50:217–223. PMID: 430134.

2. Fukamachi A, Nagaseki Y, Kohno K, Wakao T. The incidence and developmental process of delayed traumatic intracerebral haematomas. Acta Neurochir (Wien). 1985; 74:35–39. PMID: 3976443.

3. Gudeman SK, Kishore PR, Miller JD, Girevendulis AK, Lipper MH, Becker DP. The genesis and significance of delayed traumatic intracerebral hematoma. Neurosurgery. 1979; 5:309–313. PMID: 503290.

4. Matsuda W, Sugimoto K, Sato N, Watanabe T, Fujimoto A, Matsumura A. Delayed onset of posttraumatic acute subdural hematoma after mild head injury with normal computed tomography: a case report and brief review. J Trauma. 2008; 65:461–463. PMID: 18288015.

5. Matsumura A, Shinohara A, Munekata K, Maki Y. Delayed intracerebral hemorrhage after ventriculoperitoneal shunt. Surg Neurol. 1985; 24:503–506. PMID: 4049225.

6. Miller JD, Nader R. Acute subdural hematoma from bridging vein rupture: a potential mechanism for growth. J Neurosurg. 2014; 120:1378–1384. PMID: 24313607.

7. Nath PC, Mishra SS, Jena SP, Tripathy SR. Delayed development of traumatic life-threatening acute subdural hematoma and its management: Challenge for neurosurgeon: A case report and review of literature. Indian J Neurosurg. 2016; 5:207–212.

8. Shabani S, Nguyen HS, Doan N, Baisden JL. Case report and review of literature of delayed acute subdural hematoma. World Neurosurg. 2016; 96:66–71. PMID: 27567576.

9. Zervas NT, Liszczak TM, Mayberg MR, Black PM. Cerebrospinal fluid may nourish cerebral vessels through pathways in the adventitia that may be analogous to systemic vasa vasorum. J Neurosurg. 1982; 56:475–481. PMID: 7062119.