Acute Spontaneous Subdural Hematoma in a Middle-aged Adult: A Case Report and Review of the Literature
Coombs JB, DO1; and Coombs BL2, BS; Chin E, MD1 (210-667-8082)
1 Department of Emergency Medicine: San Antonio Uniformed Service Health Education Consortium – San Antonio, Texas
2 Des Moines College of Osteopathic Medicine – Des Moines, Iowa
Acute spontaneous subdural hematomas (ASSDHs) are rare entities reported in the literature. A thirty-seven year old male, with no
history of trauma, presented to the emergency department (ED) with a headache, myalgias, and vomiting. Noncontrast computed
tomography (CT) revealed a unilateral ASSDH with 9 mm midline shift and a normal neurological exam. Within twenty-four hours,
the patient developed an abducen’s palsy and, interpreted as a sign of increasing intracranial pressure, was taken for an urgent
hemicraniectomy. Pathological sampling revealed large atypical cells indicative of a possible hematopoietic neoplasm. There was no
sign of cerebral tumor, vascular malformation, or arterial extravasation identified by various imaging modalities. A literature review
of the etiology, incidence, and mortality rates of ASSDH is discussed as these nontraumatic cases are limited to case reports and a few
case series—especially in nonelderly patients.