두개내 급성 경막하 혈종의 급속 자연 관해에 관한 증례 보고

초록

PURPOSE : Intracranial acute subdural hematoma (ASDH) has mortality up to 40%, as usual, large amount ASDH needs to remove prompt by surgical methods. Rapid resolution of intracranial ASDH on computed tomography (CT) and magnetic resonance imaging (MRI) image is a known phenonmenon with a number of reported case. We experienced similar case that rapid resolution of intracranial ASDH. MATERIALS AND METHODS : A 48-year-old woman was transferred to out hospital after passenger traffic accident. During transfer, her consciousness level reduced and when she arrived to our hospital, she was comatous Glasgow Coma Scale of E1V1M1 and prompted light reflex . Skull X-ray and Brain CT scan demonstrated a left frontotemporal ASDH and midline shift of about 6mm without skull fracture. Her consciousness level improved gradually, therefore we decided to conservative treatment. After 4 hours from admission, she was alert, and oriented. No focal neurologic deficits were presented. Because of the findings on previous Brain CT scan and our neurological examination did not matched, we repeated Brain CT scan at 6 hours later from admission. ASDH seen on previous Brain CT scan was disappeared spontaneously and midline shifting had recovered. But minimal SAH newly appeared at both cerebral vertex. Repeat Brain CT scans taken three days after admission revealed no brain edema and hemorrhage. She discharged without neurologic deficits. RESULTS : Intracranial ASDH is one of critical cause of death, as usual, large amount ASDH often needs to remove prompt by surgical methods. However conservative treatment with careful monitoring is considerable in selected patients who show neurological and radiological improvement or in neurologically stable patients. But only 37 cases of ASDH showing rapid spontaneous resolution have been reported until 2005 and about 10 cases after than. It is difficult to explain the mechanism of rapid resolution of ASDH, several possible mechanisms for the spontaneous r