# Rapid neurological recovery with spontaneous resolution of acute subdural hematoma after severe head trauma: A case report of auto-decompression phenomena

## TL;DR

A rare case of spontaneous recovery from severe head trauma shows how acute subdural hematoma can resolve without surgery, highlighting unpredictable outcomes in traumatic brain injury.

## Contribution

This case report presents a rare instance of spontaneous resolution of bilateral acute subdural hematoma following severe head trauma, emphasizing the role of specific clinical factors.

## Key findings

- Spontaneous resolution of bilateral acute subdural hematoma occurred within 72 hours without surgery.
- Factors like extensive skull fractures, coagulopathy, and chronic alcoholism may contribute to auto-decompression.
- The case highlights the unpredictable recovery trajectory in traumatic brain injury management.

## Abstract

The spontaneous resolution of acute subdural hematoma (aSDH) represents an ill-defined but clinically significant phenomenon in traumatic brain injury (TBI). While surgical evacuation remains the standard of care for significant aSDH, rare cases of spontaneous resolution, termed auto-decompression in literature, suggest alternative pathways of hematoma clearance that warrant further investigation.

We discuss the case of a 40-year-old male with background seizure disorder who fell off a ladder. His Glasgow Coma Score (GCS) at presentation was 5. Brain Computed Tomography (CT) scan revealed bilateral aSDH and multiple skull fractures. Within 24 h, his GCS quickly improved to 9 T. Repeat brain CT done 72 h post-trauma showed resolution of the aSDH following non-operative management.

Spontaneous resolution of bilateral aSDH with rapid neurological improvement is a rare but possible occurrence, often attributed to auto-decompression phenomenon in patients with severe head trauma and specific predisposing factors. Our discussion revolves around this patients presentation with polytrauma, complex skull fractures, history of craniotomy, and acute coagulopathy contributing to the spontaneous resolution of the hematoma. Given the complex nature of TBI and the unpredictable course of recovery, clinicians must remain vigilant in continuously reassessing neurological status.

This case discusses the unpredictable nature of TBI and highlights the rapid and unexpected resolution of aSDH in a patient with complex neurosurgical history, coagulopathy, and polytrauma. The findings showcase the problems of polytraumatized patients and exemplify the importance of individualized care even when initial signs indicate poor prognosis.

•Rare case of spontaneous hematoma resolution post-TBI•Extensive skull fractures, coagulopathy, and chronic alcoholism are factors that can aid in spontaneous resolution•Emphasized the unpredictable recovery trajectory in severe TBI management

Rare case of spontaneous hematoma resolution post-TBI

Extensive skull fractures, coagulopathy, and chronic alcoholism are factors that can aid in spontaneous resolution

Emphasized the unpredictable recovery trajectory in severe TBI management