Development of a Delayed Posttraumatic Acute Subdural Hematoma
BACKGROUND: Prior studies have shown that most patients with mild traumatic brain injury (TBI) or negative computed tomography (CT) scans of the head rarely decline or require neurosurgical interventions. One common reason for a delayed decline is an intracranial hemorrhage which presents within 24 to 48 hours. This is typically seen in elderly patients and/or patients on antiplatelet or anticoagulation agents. We describe a case of a delayed subdural hemorrhage presenting in a young adult not on any antiplatelet or anticoagulation therapy. CASE DESCRIPTION: A 19 year old male presented to the emergency room after being involved in a motor vehicle accident. He had a Glasgow coma scale of 15 and an initial CT was negative for any intracranial hemorrhage or pathology, so he was then admitted to the ICU for further care. The patient received one dose of aspirin 325mg the following day for treatment of blunt cerebrovascular injury. 6 hours later he reported a severe headache and had an episode of emesis with a subsequent rapid neurologic decline. A repeat CT showed an acute right subdural hematoma and he underwent an emergent right decompressive hemicraniectomy. CONCLUSION: In rare cases, patients with negative initial head CT scans neurologically deteriorate as a result of a delayed acute subdural hematoma. We present an unusual case of a young patient on no medications with no CT findings of an intracranial injury who neurologically declined due to a delayed acute subdural hematoma.
Rybkin, I., Kim, M., Amin, A., & Tobias, M. (2018). Development of a Delayed Posttraumatic Acute Subdural Hematoma. World Neurosurgery, 117, 353-356. https://doi.org/10.1016/j.wneu.2018.06.135