Spontaneous rapid resolution of acute subdural hematoma after head trauma: Is it truly rare?

Spontaneous rapid resolution of acute subdural hematoma (ASDH) is a rare phenomenon for this severe insult after head trauma. We present a 22-year-old patient who developed ASDH with a moderate midline shift and compression of lateral ventricle after a truncal collision but without a direct beat on the head. Conservative management was performed under close monitoring because of unexpected improvement of clinical signs and symptoms. Unexpectedly, the ASDH resolved spontaneously within 13 h after the trauma, and he was discharged 1 week later without any neurological deficit. In addition, similar cases reported in literature were reviewed. Because most of the patients developing ASDH underwent emergent surgical intervention, the incidence of this phenomenon may be underestimated. Although emergent surgical removal remains the first choice for the treatment of ASDH, conservative management with careful monitoring may also work out in selected patients who show neurologic and radiologic improvements.