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Vol. 13. Issue 6.
Pages 486-489 (January 2002)
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Vol. 13. Issue 6.
Pages 486-489 (January 2002)
Resolución espontánea de un hematoma subdural agudo
Spontaneous resolution of an acute subdural hematoma
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J.J. Rivas
, J. Domínguez, A.P. Avila, V. Martín, A. Reyes
Servicio de Neurocirugía. Hospital Ntra. Sra. de la Candelaria. Santa Cruz de Tenerife
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Resumen

E1 hematoma subdural agudo es una entidad clínica de muy mal pronóstico y el tratamiento ha consistido clásicamente en su evacuación quirúrgica urgente. Son muy pocos los casos descritos en los que el hematoma se ha resuelto de forma espontánea y rápida.

Presentamos una paciente que sufrió un traumatismo craneal y fue diagnosticada de un hematoma subdural agudo que desapareció sin intervención. En la TC el hematoma provocaba un notable efecto de masa y tenía en su periferia una hipodensidad que sugería la presencia de LCR en el espacio subdural. El mecanismo de resolución del hematoma creemos se debió al lavado del mismo por el LCR a través de una rotura en la aracnoides. Otro mecanismo de desaparición del hematoma descrito en la literatura es por redistribución de la sangre en el espacio subdural, pero ésto no pudo confirmarse en nuestro caso.

En algunos pacientes con hematoma subdural agudo, que reunan determinados criterios, se podría adoptar una actitud inicial conservadora.

Palabras clave:
Traumatismo craneoencefálico
Hematoma subdural agudo
Tomografía computarizada
Resolución espontánea
Tratamiento conservador
Summary

Acute postraumatic subdural hematoma is known to have bad prognosis. Traditionally, its treatment consisted in urgent surgical evacuation. Rapid spontaneous resolution of the hematoma has been infrequently observed.

We report a case of a patient with an acute traumatic subdural hematoma which disappeared without surgery. CT-scan showed a left-sided subdural hematoma with marked mass effect. A low density layer, which implied involvement of CSF in the subdural space, was observed between the hematoma and the inner wall of the skull. We think that the spontaneous resolution of the hematoma was due to the dilution and washing-out by the CSF through an arachnoid tear. Another suggested mechanism in the literature is blood redistribution in the subdural space.

Selected patients with an acute subdural hematoma can be managed with conservative treatment.

Key words:
Head injury
Acute subdural hematoma
Computerized tomography
Spontaneous resolution
Conservative treatment

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