title: Acute spontaneous subdural hematoma in a middle-aged adult: case report and review of the literature.
abstract: BACKGROUND
  Acute spontaneous subdural hematomas (ASSDH) occur by a variety of pathological processes and are less common than trauma-related acute subdural hematomas (SDH). Both types are usually seen in the elderly, and only 22 cases of ASSDH in patients aged < 40 years have been reported in the medical literature.
  
  
  OBJECTIVE
  We report a rare case of ASSDH in a middle-aged male with no previous history of head trauma. A literature review comparing the clinical presentations, etiologies, incidence, mortality rates, and prognostic factors of ASSDH in various age groups is discussed.
  
  
  METHODS
  A 37-year-old man presented to the Emergency Department with headaches, myalgias, and vomiting. Noncontrast computed tomography revealed a unilateral ASSDH with 9 mm of midline shift, despite a normal neurological examination. Upon admission, the patient developed an abducens palsy suggesting increased intracranial pressure and underwent an urgent hemicraniectomy. Pathological sampling revealed large atypical cells indicative of a hematopoietic neoplasm, but various advanced imaging modalities failed to identify signs of cerebral tumor, vascular malformation, or arterial extravasation.
  
  
  CONCLUSIONS
  Given the rarity of SDH in nonelderly patients, this case suggests a broader differential diagnosis for nontraumatic headaches to include arterial and even neoplastic origins. Our literature review confirms the paucity of reported incidences of ASSDH, yet reminds medical providers to closely monitor for developing neurological symptoms and initiate prompt medical intervention when necessary.
authors.affiliation: Department of Emergency Medicine, Joint Base Elmendorf-Richardson (JBER) DoD/VA, Joint Venture Hospital, JBER, Alaska.
authors.forename: Jaron B
authors.initials: JB
authors.lastname: Coombs
authors.affiliation: Des Moines University College of Osteopathic Medicine, Des Moines, Iowa.
authors.forename: Bryce L
authors.initials: BL
authors.lastname: Coombs
authors.affiliation: Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Chin
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D006261:Headache / Q000175:diagnosis; D020199:Hematoma, Subdural, Acute / Q000175:diagnosis*; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis
keywords: acute spontaneous subdural hematoma; headache; idiopathic; nontraumatic