Spontaneously Rapid Resolution of Acute Subdural Hemorrhage with Severe Midline Shift
A 40-year-old female patient presented with decrease of consciousness following accident. Initially, she was stuporous and measured as glasgow coma scale (GCS) score of 6. Both pupils were dilated as 5 mm and reactive to light. Brain computed tomography (CT) revealed an acute subdural hematoma with a thickness of 10 mm in the right frontotemporoparietal region. Midline shift caused by mass effects was 15 mm (). Craniotomy for hematoma removal was considered during close observation. However, an unexpected neurological improvement was noted within 1 hour following the accident. The patient was obeyed and GCS score was 10 even though intubated. A follow-up brain CT showed a decrease in the thickness of hematoma and improvement of the midline shift (). On the third day following the accident, brain CT showed a remarkable reduction of acute subdural hematoma and mass effect. The hemorrhages of subdural space around falx, tentorium, posterior fossa, and upper cervical spinal canal were not found (). The patient recovered her consciousness completely without any neurosurgical interventions.