Introduction: We report a case of craniotomy performed in the emergency department (ED) for a non-traumatic acute subdural hematoma.
Case: An 84-year-old man with long-term psychiatric hospitalization independently performed activities of daily living.
History: While watching TV, he vomited and started losing consciousness. Head computed tomography (CT) revealed a left-sided acute subdural hematoma, and he was transferred to our hospital via ambulance. On admission, his Glasgow Coma Scale (GCS) (E1, V1, and M4) showed pupils 2.0 mm/3.0 mm, sluggish light reflexes bilaterally, and right hemiplegia. Following head CT, his consciousness level deteriorated to GCS (E1, V1, M2), pupils 2.0 mm/5.0 mm, and bilateral loss of the light reflex. He developed a non-traumatic acute subdural hematoma without cerebral contusion. The ED performed a craniotomy for hematoma removal. On postoperative day 27, he was transferred to psychiatric care.
Conclusion: Since non-traumatic acute subdural hematoma does not cause brain contusion, an early craniotomy may improve its prognosis. Prompt interprofessional coordination between a neurosurgeon, anesthesiologist, and operating theater nurse for emergency craniotomies and hematoma removal in the ED may be a useful therapeutic strategy in such cases.
