Rapid Resolution of Acute Subdural Hematoma in a Coagulopathic Patient

80% mortality rate and is considered a neurosurgical emergency. Although it is most often treated with emergent surgical decompression, patients may be managed conservatively when they are neurologically intact or the hematoma is small. Typical progression of aSDH resolution occurs over weeks, and is characterized by corresponding changes on radiographic imaging where bright aSDH becomes first isointense at about two weeks and then hypointense on noncontrast computed tomogram (CT) head imaging. If there is continued bleeding acutely, however, the SDH may increase in size leading to transtentorial herniation and subsequent clinical deterioration of the patient. Interestingly, there are a number of case reports in the literature describing the event of spontaneous aSDH resolution. Several hypotheses have been put forward to explain this phenomenon including redistribution of subdural blood and dilution by cerebral spinal fluid (CSF)1. Cerebral atrophy, as well as cerebral swelling were both identified to facilitate aSDH resolution2,3. Here we describe a patient with an unexpected resolution of an acute SDH in the setting of a bleeding diathesis, and propose that in this patient, coagulopathy contributed to the spontaneous resolution of the hematoma.