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Vol. 13. Issue 6.
Pages 491-494 (January 2002)
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Vol. 13. Issue 6.
Pages 491-494 (January 2002)
Resolución precoz espontánea de hematoma subdural agudo intracraneal
Rapid spontaneous resolution of acute subdural hematoma
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I. Fernández-Portales
, L. Gómez-Perals, J.M. Cabezudo, J. Giménez-Pando, L.G. Yagüe
Servicio de Neurocirugía. Hospital Universitario Infanta Cristina. Badajoz
J.A. Figueroa*
* Unidad de Cuidados Intensivos. Hospital Universitario Infanta Cristina. Badajoz
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Resumen

Los hematomas subdurales agudos en general constituyen una urgencia neuroquirúrgica. En casos seleccionados, está indicado como primera alternativa el tratamiento conservador con estrecha vigilancia neurológica. En algunos de estos pacientes se aprecia la resolución progresiva del hematoma. Sin embargo, la resolución precoz espontánea de un hematoma subdural agudo es un fenómeno muy poco frecuente. Se describe el caso de un paciente con antecedentes de alcoholismo crónico que sufrió traumatismo craneoencefálico con hematoma subdural agudo, en el que se apreció resolución espontánea del hematoma en menos de 18h, acompañado de mejoría clínica. Se discute la fisiopatología de la resolución precoz del hematoma. El desgarro de la aracnoides con fuga de LCR al espacio subdural junto con el control de la presión intracraneal y la atrofia cerebral, condicionarían el efecto de lavado y redistribución del hematoma que provocan su desaparición en la TC cerebral.

Palabras clave:
Hematoma subdural agudo
Resolución espontánea
Traumatismo craneoencefálico
Tratamiento conservador
Atrofia cerebral
Summary

Acute subdural hematomas are usually neurosurgical emergencies, although a conservative therapy is indicated in selected cases. In some of these patients a progressive resolution is appreciated. However, rapid spontaneous resolution of an acute suddural hematoma is seldom reported. A patient with antecedent of chronic alcoholism and spontaneous resolution of acute subdural hematoma in less than 18 hours after the head injury is described. The possible mechanisms of this rapid resolution are discussed. A tear in the arachnoid with spilling of CSF into the subdural space and the effect of intracranial antihypertensive measures together with cerebral atrophy, are factors that possibly contribute to dilution and redistribution of blood with hematoma disappearing in CT sean.

Key words:
Acute subdural hematoma
Spontaneous resolution
Head trauma
Conservative treatment
Cerebral atrophy

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