Redistribution of hematoma to spinal subdural space as a mechanism for the rapid spontaneous resolution of posttraumatic intracranial acute subdural hematoma: case report.
BACKGROUND
Rapid spontaneous resolution of posttraumatic intracranial ASDH has been reported in the literature since 1986. We report a case to demonstrate that redistribution of hematoma to the spinal subdural space is a mechanism for the rapid spontaneous resolution of posttraumatic intracranial ASDH.


METHODS
A 73-year-old woman with a slipped-and-fell injury had a worst GCS score of 8/15. Computerized tomography of the brain demonstrated a large intracranial ASDH with mass effect. Conservative management was decided because of her poor premorbid general condition. Rapid clinical improvement was observed within 5 hours after the CT. Progress CT of the brain at 45 hours postinjury showed that the size of the intracranial ASDH was markedly diminished. The CT findings apparently demonstrated a caudal distribution of the intracranial ASDH over the tentorium and then into the posterior fossa. To investigate this further, an MRI of the spine was performed, which showed that there was spinal SDH in the cervical and thoracic spine.


CONCLUSIONS
This is the first report demonstrating that redistribution of posttraumatic intracranial ASDH to the spinal subdural space is one of the mechanisms behind the rapid spontaneous resolution of posttraumatic intracranial ASDH in the acute phase.
Wong
Sui To
ST
Department of Neurosurgery, Tuen Mun Hospital, Tuen Mun, Hong Kong. wongsuito@hotmail.com
Yuen
Ming Keung
MK
Fok
Kam Fuk
KF
Yuen
Shing Chau
SC
Yam
Kwong Yui
KY
Fong
Dawson
D
D000058:Accidental Falls; D000368:Aged; D003388:Cranial Fossa, Posterior / Q000473:pathology; D005260:Female; D015600:Glasgow Coma Scale; D020199:Hematoma, Subdural, Acute / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D012559:Schizophrenia / Q000150:complications; D013116:Spinal Cord / Q000473:pathology*; D014057:Tomography, X-Ray Computed