Case Report: Rapid Resolution of Acute Subdural Hematoma with Cerebral Herniation

Case Report: Rapid Resolution of Acute Subdural Hematoma with Cerebral Herniation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Case Report: Rapid Resolution of Acute Subdural Hematoma with Cerebral Herniation Zhou Yifan, Shao Tianyu, Su Guojun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7423716/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Rapid Resolution of Acute Subdural Hematoma (RRASDH) is a special type of traumatic intracranial lesion. Reports of cases where elderly patients with post-traumatic acute subdural hematoma complicated by cerebral herniation achieve spontaneous rapid resolution of the hematoma in a short time are rare in the literature. Case presentation: An 87-year-old male presented with an accidental fall. Emergency cranial computed tomography (CT) revealed a subdural hematoma complicated by cerebral herniation. The patient had no special medical history and a Glasgow Coma Scale (GCS) score of 14, so symptomatic conservative treatment was administered. A follow-up CT scan 8 hours later showed hematoma absorption and improved midline shift, and the next day, CT demonstrated nearly complete hematoma resolution. Conclusion For patients with acute subdural hematoma (ASDH) who have initially acceptable neurological status and a clinically benign course—especially elderly patients—surgical decisions require careful consideration. Trauma Acute subdural hematoma Cerebral herniation Spontaneous absorption Case Report Figures Figure 1 Figure 2 Figure 3 Background Acute Subdural hematoma (ASDH) is a common intracranial lesion in severe traumatic brain injury (TBI), which is particularly common in elderly ASDH patients (aged 65 years and above). Compared with young populations, ASDH in elderly patients may be associated with a higher mortality rate, reaching as high as 35%-88% [ 1 ] . Except for those with poor general condition or irreversible brain damage, most patients undergo emergency neurosurgical intervention. Surgery should be performed regardless of the patient's Glasgow Coma Scale (GCS) score if the midline shift exceeds 5 mm or the maximum thickness of the hematoma is greater than 10 mm [ 2 ] . Spontaneous resolution of ASDH is a rare phenomenon, with extremely low incidence in clinical practice. Herein, we report a case of subdural hematoma complicated by cerebral herniation, in which the hemorrhage underwent spontaneous absorption and the midline shifted back to normal within a short period. Case presentation An 87-year-old male patient accidentally fell, with his right head and face hitting the ground. Immediately after the fall, he experienced headache accompanied by nausea and vomiting, without loss of consciousness. He was urgently transported to our hospital by his family members, and an emergency cranial computed tomography (CT) scan (Fig. 1) performed at 00:26 revealed a left frontotemporoparietal-occipital subdural hematoma with cerebral herniation formation, showing a midline shift of approximately 13 mm, without obvious parenchymal contusion. The patient had no special medical history. On physical examination: the consciousness was clear, there was ecchymosis and swelling of the right periorbital soft tissue, the muscle strength of the right limbs was grade 4, no obvious motor deficits or pupillary abnormalities were found, and the Glasgow Coma Scale score was 14. We communicated with the patient's family members and recommended emergency surgical treatment. However, considering the patient's mental state and his advanced age, the family members refused surgery and requested conservative treatment. The patient was then admitted to our department, where he received symptomatic and supportive treatments such as mannitol administration, blood pressure control, and antiemetic therapy. A re-examination of CT (Fig. 2) was performed 8 hours later, which showed that the hemorrhage had been absorbed compared with the previous scan, and the midline shift had improved. A follow-up CT scan (Fig. 3) on the next day showed that the midline had returned to normal, the hemorrhage had almost completely resolved, and there was no cerebral edema. After conservative treatment, the patient was discharged on the 5th day after the trauma with good neurological status and no deficits. Discussion and conclusion ASDH is typically caused by head trauma. Without timely treatment, it can lead to severe complications with an extremely high mortality rate. Emergency surgery is currently recognized as the preferred treatment modality, which can significantly improve the patient's prognosis. However, there have been an increasing number of literature reports documenting cases of ASDH that rapidly resolve spontaneously within hours or days. This has introduced new considerations regarding the timing of emergency surgery for such conditions.Jae—Young Park et al. [ 3 ] reported a case of rapid resolution of severe traumatic subdural hematoma in a child. They suggested that when children with severe head injuries show any signs of neurological improvement, a follow-up CT scan is strongly recommended before surgery, especially when a mixed-density hematoma is present on the initial CT scan.L·Wen et al. [ 4 ] consecutively collected 19 cases of spontaneous rapid resolution of ASDH. They proposed that several common features among most patients with rapid resolution of ASDH include transient coma lasting no more than 12 hours after head trauma, absence of cerebral contusion, and presence of a low-density band between the hematoma and the inner table of the skull on CT images. Fujimoto et al. [ 5 ] analyzed 18 patients with rapid spontaneous resolution of ASDH between 2006 and 2012. They suggested that the use of antiplatelet drugs prior to head injury and the presence of a low-density band between the hematoma and the inner skull on CT images (indicating cerebrospinal fluid leakage into the subdural space) are two predictive factors for the rapid resolution of ASDH.Brooke et al. [ 6 ] reported their 29 cases and maintained that there are two previously unrecognized predictive factors: lower comorbidity burden and prehospital anticoagulation. Currently, the phenomenon of rapid resolution of ASDH remains controversial, but there are several main hypothetical mechanisms。(1) Firstly, it is related to acute brain injury and acute brain swelling [ 7 ] . Acute cerebral swelling can exert pressure on the brain parenchyma, pushing it toward the cranial vault and thereby causing closure of the subdural space, which makes it difficult to visualize SDH on CT images. (2) Hematoma redistribution occurs via cerebrospinal fluid (CSF) due to arachnoid tear, leading to blood redistribution. The mixture of blood and CSF followed by flushing helps dilute the hemorrhage and carry it into the subarachnoid space, subdural space, or spinal subdural space [ 8 ] . CT showing a "low-density band" between the ASDH and the skull suggests cerebrospinal fluid collection [ 4 , 9 ] ; It has also been claimed that cerebral atrophy leads to widening of the subarachnoid space. This facilitates the redistribution of the hematoma, thereby promoting the clearance of ASDH.Lee et al. [ 10 ] suggested that the dilation of the subarachnoid space caused by cerebral atrophy may be a favorable factor affecting hematoma dilution and redistribution. (3) Coagulopathy or pre-illness intake of antiplatelet drugs or anticoagulants is another contributing factor that facilitates rapid resolution [ 5 , 6 , 11 , 12 ] .However, this statement runs counter to people's conventional notions, and there are relevant studies [ 13 ] expressing opposing views. Currently, no definitive conclusion has been reached. In the first CT scan of this case, obvious senile atrophy of the cerebral cortex was observed. The patient had no coagulopathy and did not take antiplatelet drugs. In the second follow-up CT, a low-density band between the ASDH and the inner table of the skull was noted. Furthermore, 32 hours later, the third follow-up CT images showed a striking reduction in the volume of the main hematoma. Therefore, it can be considered that the senile cerebral atrophy observed in the initial CT and the low-density band seen in the second CT are two predictive factors for the rapid resolution of ASDH in this patient. In conclusion,ASDH patients may experience spontaneous resolution. Cerebrospinal fluid dissolution and spatial redistribution contribute to the resolution of these hematomas. The low-density signal within the hematoma may have predictive value for supporting decisions regarding non-surgical treatment. It is noteworthy that for ASDH patients with an initially acceptable neurological status and a clinically benign course, especially elderly patients, the decision to perform surgery requires careful consideration. It is recommended to repeat CT scans before surgery to clarify the changes. Abbreviations Rapid Resolution of Acute Subdural Hematoma (RRASDH) ;Acute Subdural hematoma (ASDH)；Severe traumatic brain injury (TBI)；Glasgow Coma Scale (GCS)；Computed tomography (CT)；Cerebrospinal fluid (CSF) Declarations Ethics approval and consent to participate The study is approved by the ethics committee of Huzhou Fuyin Hospital Consent for publication Written informed consent was obtained from the patient and her family for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal. Competing interests The authors declare that they have no competing interests. Funding None. Availability of data and materials Not applicable. Authors’ contributions All authors contributed to the conception, design, and writing of this case report. Specific contributions are as follows:Z.YF: Overall management of the patient's diagnosis and treatment, preparation of the initial draft of the case report;S.TY: Overall conception and design of the study, compilation of the literature review;S.GJ: Analysis of radiological data (e.g., cranial CT scans), review and approval of the final version to be published. All authors have read and approved the final manuscript of “Case Report: Rapid Resolution of Acute Subdural Hematoma with Cerebral Herniation”. Acknowledgements Not applicable Author details 1 、 2 、 3 Department of Neurosurgery,Huzhou Fuyin Hospital, Huzhou, Zhejiang Province, 313900, PR China. References Widdop L, Kaukas L, Wells A. Effect of Pre-Management Antithrombotic Agent Use on Outcome after Traumatic Acute Subdural Hematoma in the Elderly: A Systematic Review [J]. J Neurotrauma, 2023, 40(7-8): 635-48. Wilberger J E, Walters B C, Servadei F, et al. Surgical Management of Acute Subdural Hematomas [J]. Neurosurgery, 2006, 58(suppl_3): S2-16-S2-24. Park J Y, Moon K S, Lee J K, Jeung K W. Rapid resolution of acute subdural hematoma in child with severe head injury: a case report [J]. J Med Case Rep, 2013, 7: 67. Wen L, Liu W G, Ma L, et al. Spontaneous rapid resolution of acute subdural hematoma after head trauma: is it truly rare? Case report and relevant review of the literature [J]. Ir J Med Sci, 2009, 178(3): 367-71. Fujimoto K, Otsuka T, Yoshizato K, Kuratsu J. Predictors of rapid spontaneous resolution of acute subdural hematoma [J]. Clin Neurol Neurosurg, 2014, 118: 94-7. Brooke M, Patel A, Castro-Moure F, Victorino G P. Shedding new light on rapidly resolving traumatic acute subdural hematomas [J]. J Surg Res, 2017, 219: 122-7. Punia P, Chugh A, Gotecha S, et al. Rapid Spontaneous Regression of Traumatic Subdural Hematoma [J]. J Emerg Trauma Shock, 2024, 17(4): 245-7. Vital R B, Hamamoto Filho P T, Oliveira V A, et al. Spontaneous resolution of traumatic acute subdural haematomas: A systematic review [J]. Neurocirugia (Astur), 2016, 27(3): 129-35. Kwon H C, Hwang Y S, Shin H S. Rapid Spontaneous Resolution of Large Acute Subdural Hematoma [J]. Korean J Neurotrauma, 2021, 17(2): 162-7. Lee C H, Kang D H, Hwang S H, et al. Spontaneous rapid reduction of a large acute subdural hematoma [J]. J Korean Med Sci, 2009, 24(6): 1224-6. O'Donohoe R B, Lee H Q, Tan T, et al. The Impact of Preinjury Antiplatelet and Anticoagulant Use on Elderly Patients with Moderate or Severe Traumatic Brain Injury Following Traumatic Acute Subdural Hematoma [J]. World Neurosurg, 2022, 166: e521-e7. Rickard F, Gale J, Williams A, Shipway D. New horizons in subdural haematoma [J]. Age Ageing, 2023, 52(12). Panczykowski D M, Okonkwo D O. Premorbid oral antithrombotic therapy and risk for reaccumulation, reoperation, and mortality in acute subdural hematomas [J]. J Neurosurg, 2011, 114(1): 47-52. 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16:36:18","extension":"html","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":41652,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7423716/v1/8e71df4e73334a04d45bdb4a.html"},{"id":92736451,"identity":"672c3900-c914-480b-8cf4-9f4ed798115e","added_by":"auto","created_at":"2025-10-03 16:36:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":557671,"visible":true,"origin":"","legend":"\u003cp\u003eFirst CT scan. The initial CT scan showed an acute subdural hematoma with a severe midline shift of approximately 13 mm.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7423716/v1/913a1ef628c680dfc4fc2f14.png"},{"id":92737318,"identity":"890b0068-63c0-4d97-b3aa-5e02a6789c89","added_by":"auto","created_at":"2025-10-03 16:44:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":378135,"visible":true,"origin":"","legend":"\u003cp\u003eSecond CT scan. The CT scan performed 8 hours after admission showed a low-density area in the left frontal lobe. The acute subdural hematoma had regressed compared with the previous scan, and the midline shift had improved.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7423716/v1/453a2b3195756a96f6b1f8ea.png"},{"id":92736452,"identity":"a668dee9-a541-40b7-9c1d-3490b9ee639b","added_by":"auto","created_at":"2025-10-03 16:36:17","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":402662,"visible":true,"origin":"","legend":"\u003cp\u003eThird CT scan. The brain CT scan performed 32 hours after admission showed that the acute subdural hematoma had significantly regressed, with almost complete absorption.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7423716/v1/c14c9b0f59af0fbb2e3712be.png"},{"id":104426166,"identity":"77aec446-2ec0-4139-9250-f8fd40dd590a","added_by":"auto","created_at":"2026-03-11 14:42:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2543404,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7423716/v1/965f5ec9-e806-49c4-b4dc-e778136d935e.pdf"},{"id":92736450,"identity":"0303ac17-b81f-41e2-a72d-dbaa20d6d31e","added_by":"auto","created_at":"2025-10-03 16:36:17","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":35010,"visible":true,"origin":"","legend":"","description":"","filename":"CAREchecklistEnglish20131.docx","url":"https://assets-eu.researchsquare.com/files/rs-7423716/v1/6058052ce2fa7a020b031539.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Case Report: Rapid Resolution of Acute Subdural Hematoma with Cerebral Herniation","fulltext":[{"header":"Background","content":"\u003cp\u003eAcute Subdural hematoma (ASDH) is a common intracranial lesion in severe traumatic brain injury (TBI), which is particularly common in elderly ASDH patients (aged 65 years and above). Compared with young populations, ASDH in elderly patients may be associated with a higher mortality rate, reaching as high as 35%-88%\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Except for those with poor general condition or irreversible brain damage, most patients undergo emergency neurosurgical intervention. Surgery should be performed regardless of the patient's Glasgow Coma Scale (GCS) score if the midline shift exceeds 5 mm or the maximum thickness of the hematoma is greater than 10 mm\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Spontaneous resolution of ASDH is a rare phenomenon, with extremely low incidence in clinical practice. Herein, we report a case of subdural hematoma complicated by cerebral herniation, in which the hemorrhage underwent spontaneous absorption and the midline shifted back to normal within a short period.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eAn 87-year-old male patient accidentally fell, with his right head and face hitting the ground. Immediately after the fall, he experienced headache accompanied by nausea and vomiting, without loss of consciousness. He was urgently transported to our hospital by his family members, and an emergency cranial computed tomography (CT) scan (Fig. 1) performed at 00:26 revealed a left frontotemporoparietal-occipital subdural hematoma with cerebral herniation formation, showing a midline shift of approximately 13 mm, without obvious parenchymal contusion. The patient had no special medical history. On physical examination: the consciousness was clear, there was ecchymosis and swelling of the right periorbital soft tissue, the muscle strength of the right limbs was grade 4, no obvious motor deficits or pupillary abnormalities were found, and the Glasgow Coma Scale score was 14. We communicated with the patient's family members and recommended emergency surgical treatment. However, considering the patient's mental state and his advanced age, the family members refused surgery and requested conservative treatment. The patient was then admitted to our department, where he received symptomatic and supportive treatments such as mannitol administration, blood pressure control, and antiemetic therapy. A re-examination of CT (Fig. 2) was performed 8 hours later, which showed that the hemorrhage had been absorbed compared with the previous scan, and the midline shift had improved. A follow-up CT scan (Fig. 3) on the next day showed that the midline had returned to normal, the hemorrhage had almost completely resolved, and there was no cerebral edema. After conservative treatment, the patient was discharged on the 5th day after the trauma with good neurological status and no deficits.\u003c/p\u003e\n"},{"header":"Discussion and conclusion","content":"\u003cp\u003eASDH is typically caused by head trauma. Without timely treatment, it can lead to severe complications with an extremely high mortality rate. Emergency surgery is currently recognized as the preferred treatment modality, which can significantly improve the patient's prognosis. However, there have been an increasing number of literature reports documenting cases of ASDH that rapidly resolve spontaneously within hours or days. This has introduced new considerations regarding the timing of emergency surgery for such conditions.Jae—Young Park et al.\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e reported a case of rapid resolution of severe traumatic subdural hematoma in a child. They suggested that when children with severe head injuries show any signs of neurological improvement, a follow-up CT scan is strongly recommended before surgery, especially when a mixed-density hematoma is present on the initial CT scan.L·Wen et al.\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e consecutively collected 19 cases of spontaneous rapid resolution of ASDH. They proposed that several common features among most patients with rapid resolution of ASDH include transient coma lasting no more than 12 hours after head trauma, absence of cerebral contusion, and presence of a low-density band between the hematoma and the inner table of the skull on CT images. Fujimoto et al.\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e analyzed 18 patients with rapid spontaneous resolution of ASDH between 2006 and 2012. They suggested that the use of antiplatelet drugs prior to head injury and the presence of a low-density band between the hematoma and the inner skull on CT images (indicating cerebrospinal fluid leakage into the subdural space) are two predictive factors for the rapid resolution of ASDH.Brooke et al.\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e reported their 29 cases and maintained that there are two previously unrecognized predictive factors: lower comorbidity burden and prehospital anticoagulation.\u003c/p\u003e\u003cp\u003eCurrently, the phenomenon of rapid resolution of ASDH remains controversial, but there are several main hypothetical mechanisms。(1) Firstly, it is related to acute brain injury and acute brain swelling\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Acute cerebral swelling can exert pressure on the brain parenchyma, pushing it toward the cranial vault and thereby causing closure of the subdural space, which makes it difficult to visualize SDH on CT images. (2) Hematoma redistribution occurs via cerebrospinal fluid (CSF) due to arachnoid tear, leading to blood redistribution. The mixture of blood and CSF followed by flushing helps dilute the hemorrhage and carry it into the subarachnoid space, subdural space, or spinal subdural space\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. CT showing a \"low-density band\" between the ASDH and the skull suggests cerebrospinal fluid collection\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e; It has also been claimed that cerebral atrophy leads to widening of the subarachnoid space. This facilitates the redistribution of the hematoma, thereby promoting the clearance of ASDH.Lee et al.\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e suggested that the dilation of the subarachnoid space caused by cerebral atrophy may be a favorable factor affecting hematoma dilution and redistribution. (3) Coagulopathy or pre-illness intake of antiplatelet drugs or anticoagulants is another contributing factor that facilitates rapid resolution\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e.However, this statement runs counter to people's conventional notions, and there are relevant studies \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e expressing opposing views. Currently, no definitive conclusion has been reached.\u003c/p\u003e\u003cp\u003eIn the first CT scan of this case, obvious senile atrophy of the cerebral cortex was observed. The patient had no coagulopathy and did not take antiplatelet drugs. In the second follow-up CT, a low-density band between the ASDH and the inner table of the skull was noted. Furthermore, 32 hours later, the third follow-up CT images showed a striking reduction in the volume of the main hematoma. Therefore, it can be considered that the senile cerebral atrophy observed in the initial CT and the low-density band seen in the second CT are two predictive factors for the rapid resolution of ASDH in this patient.\u003c/p\u003e\u003cp\u003eIn conclusion,ASDH patients may experience spontaneous resolution. Cerebrospinal fluid dissolution and spatial redistribution contribute to the resolution of these hematomas. The low-density signal within the hematoma may have predictive value for supporting decisions regarding non-surgical treatment. It is noteworthy that for ASDH patients with an initially acceptable neurological status and a clinically benign course, especially elderly patients, the decision to perform surgery requires careful consideration. It is recommended to repeat CT scans before surgery to clarify the changes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eRapid Resolution of Acute Subdural Hematoma (RRASDH) ;Acute Subdural hematoma (ASDH)；Severe traumatic brain injury (TBI)；Glasgow Coma Scale (GCS)；Computed tomography (CT)；Cerebrospinal fluid (CSF)\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study is approved by the ethics committee of Huzhou Fuyin Hospital\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient and her family for\u003c/p\u003e\n\u003cp\u003epublication of this case report and any accompanying images. A copy of the\u003c/p\u003e\n\u003cp\u003ewritten consent is available for review by the Editor of this journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the conception, design, and writing of this case report. Specific contributions are as follows:Z.YF: Overall management of the patient\u0026apos;s diagnosis and treatment, preparation of the initial draft of the case report;S.TY: Overall conception and design of the study, compilation of the literature review;S.GJ: Analysis of radiological data (e.g., cranial CT scans), review and approval of the final version to be published.\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the final manuscript of\u0026nbsp;\u0026ldquo;Case Report: Rapid Resolution of Acute Subdural Hematoma with Cerebral Herniation\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e\u003csup\u003e、\u003c/sup\u003e\u003csup\u003e2\u003c/sup\u003e\u003csup\u003e、\u003c/sup\u003e\u003csup\u003e3\u003c/sup\u003eDepartment of Neurosurgery,Huzhou Fuyin Hospital, Huzhou, Zhejiang Province, 313900, PR China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWiddop L, Kaukas L, Wells A. Effect of Pre-Management Antithrombotic Agent Use on Outcome after Traumatic Acute Subdural Hematoma in the Elderly: A Systematic Review [J]. J Neurotrauma, 2023, 40(7-8): 635-48.\u003c/li\u003e\n\u003cli\u003eWilberger J E, Walters B C, Servadei F, et al. Surgical Management of Acute Subdural Hematomas [J]. Neurosurgery, 2006, 58(suppl_3): S2-16-S2-24.\u003c/li\u003e\n\u003cli\u003ePark J Y, Moon K S, Lee J K, Jeung K W. Rapid resolution of acute subdural hematoma in child with severe head injury: a case report [J]. J Med Case Rep, 2013, 7: 67.\u003c/li\u003e\n\u003cli\u003eWen L, Liu W G, Ma L, et al. Spontaneous rapid resolution of acute subdural hematoma after head trauma: is it truly rare? Case report and relevant review of the literature [J]. Ir J Med Sci, 2009, 178(3): 367-71.\u003c/li\u003e\n\u003cli\u003eFujimoto K, Otsuka T, Yoshizato K, Kuratsu J. Predictors of rapid spontaneous resolution of acute subdural hematoma [J]. Clin Neurol Neurosurg, 2014, 118: 94-7.\u003c/li\u003e\n\u003cli\u003eBrooke M, Patel A, Castro-Moure F, Victorino G P. Shedding new light on rapidly resolving traumatic acute subdural hematomas [J]. J Surg Res, 2017, 219: 122-7.\u003c/li\u003e\n\u003cli\u003ePunia P, Chugh A, Gotecha S, et al. Rapid Spontaneous Regression of Traumatic Subdural Hematoma [J]. J Emerg Trauma Shock, 2024, 17(4): 245-7.\u003c/li\u003e\n\u003cli\u003eVital R B, Hamamoto Filho P T, Oliveira V A, et al. Spontaneous resolution of traumatic acute subdural haematomas: A systematic review [J]. Neurocirugia (Astur), 2016, 27(3): 129-35.\u003c/li\u003e\n\u003cli\u003eKwon H C, Hwang Y S, Shin H S. Rapid Spontaneous Resolution of Large Acute Subdural Hematoma [J]. Korean J Neurotrauma, 2021, 17(2): 162-7.\u003c/li\u003e\n\u003cli\u003eLee C H, Kang D H, Hwang S H, et al. Spontaneous rapid reduction of a large acute subdural hematoma [J]. J Korean Med Sci, 2009, 24(6): 1224-6.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Donohoe R B, Lee H Q, Tan T, et al. The Impact of Preinjury Antiplatelet and Anticoagulant Use on Elderly Patients with Moderate or Severe Traumatic Brain Injury Following Traumatic Acute Subdural Hematoma [J]. World Neurosurg, 2022, 166: e521-e7.\u003c/li\u003e\n\u003cli\u003eRickard F, Gale J, Williams A, Shipway D. New horizons in subdural haematoma [J]. Age Ageing, 2023, 52(12).\u003c/li\u003e\n\u003cli\u003ePanczykowski D M, Okonkwo D O. Premorbid oral antithrombotic therapy and risk for reaccumulation, reoperation, and mortality in acute subdural hematomas [J]. J Neurosurg, 2011, 114(1): 47-52.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Trauma, Acute subdural hematoma, Cerebral herniation, Spontaneous absorption, Case Report","lastPublishedDoi":"10.21203/rs.3.rs-7423716/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7423716/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eRapid Resolution of Acute Subdural Hematoma (RRASDH) is a special type of traumatic intracranial lesion. Reports of cases where elderly patients with post-traumatic acute subdural hematoma complicated by cerebral herniation achieve spontaneous rapid resolution of the hematoma in a short time are rare in the literature.\u003c/p\u003e\u003ch2\u003eCase presentation:\u003c/h2\u003e\u003cp\u003eAn 87-year-old male presented with an accidental fall. Emergency cranial computed tomography (CT) revealed a subdural hematoma complicated by cerebral herniation. The patient had no special medical history and a Glasgow Coma Scale (GCS) score of 14, so symptomatic conservative treatment was administered. A follow-up CT scan 8 hours later showed hematoma absorption and improved midline shift, and the next day, CT demonstrated nearly complete hematoma resolution.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eFor patients with acute subdural hematoma (ASDH) who have initially acceptable neurological status and a clinically benign course\u0026mdash;especially elderly patients\u0026mdash;surgical decisions require careful consideration.\u003c/p\u003e","manuscriptTitle":"Case Report: Rapid Resolution of Acute Subdural Hematoma with Cerebral Herniation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-03 16:36:13","doi":"10.21203/rs.3.rs-7423716/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7afadd9f-1666-4937-87ad-2e508b12e870","owner":[],"postedDate":"October 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-11T14:41:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-03 16:36:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7423716","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7423716","identity":"rs-7423716","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}