Swift Spontaneous Regression Of A Pediatric Traumatic Acute Subdural Hematoma
Koppen, H., Arkink, E., Nordbeck, A., Sie, L., & van der Gaag, N. (2019). Swift Spontaneous Regression of a Pediatric Traumatic Acute Subdural Hematoma. Case reports in neurology, 11(3), 351–356. https://doi.org/10.1159/000504468
View Original Source →Abstract
We report the case of a 4-year-old girl with acute subdural hematoma who presented to the emergency department after an unwitnessed fall of the balcony. The hematoma was hyperdense along the left convexity of 9 mm thickness with a consequent mass effect with obliteration of the adjacent sulci, left lateral ventricle compression and a midline shift of 7 mm. During her stay in the emergency department while waiting for transfer to the children intensive care unit elsewhere she slightly deteriorated neurologically. Repeat CT scan of the brain 4 h after initial presentation remarkably showed that the subdural hematoma had now largely disappeared, with a decrease in volume and density. Consequently, the mass effect diminished with a near normalization of the midline shift.
Case Details
Disease Location
Brain
Personal Characteristics
4-year-old girl
Clinical Characteristics
Admitted to the emergency department after being found outside on the ground floor of their first-floor apartment. To relief the pain, 1 mg morphine was administered. CT scan showed a hyperdense acute subdural hematoma (asdh) along the left convexity of 9 mm thickness with a consequent mass effect with obliteration of the adjacent sulci, left lateral ventricle compression and a midline shift of 7 mm there was a thin band of low density on the inner margin of the hematoma, possibly representing cerebrospinal fluid (csf) in the subdural space from an arachnoid tear. Chest x-ray revealed a limited right-sided pneu- mothorax without evidence of any rib fractures. Within 4 h after initial presentation her gsc score slightly deteriorated to e3m6v3 with normal pupil reflexes.
Remission Characteristics
Repeat CT scan of the brain was performed which remarkably showed that the subdural hematoma had now largely disappeared, with a decrease in volume and density.
Treatment & Mechanisms
Proposed Remission Mechanisms
The hematoma was exposed, diluted and washed out by csf in the subarachnoidal space through a traumatically ruptured arachnoid membrane.
Clinical Treatment
Morphine
Non-Clinical Treatment
None reported