Expansion of traumatic acute subdural hematoma with Spot Sign positive during oral antithrombotic therapy

Abstract

Mild acute traumatic subdural hematoma is gen­erally treated conservatively. However, some he­ma­toma which have been treated conserva­tively on admission become expanded and need surgery. Contrast–enhanced Computerized Tomo­graphy (CT) is not conventionally used to predict failed conservative treatment in our hospital. In the present study, we report a trauma­tic acute subdural hematoma (ASDH) with a spot sign that required a delayed emer­gency craniotomy. An 80–year–old male, who regularly used anticoagulant agents, took a fall down and was transferred to our emergency department. On admission, we observed a left ASDH in the Head CT scans, and one hour after admission, a high density spot (spot sign) was observed in the hematoma in contrast CT imag­ing. As a result, we opted for the conservative treatment. However, six hours after admission, right hemiparesis appeared and the patient fell into a coma. We performed an emergency cra­nio­tomy and removed the hematoma. He was transferred to a community hospital in about 140 days after admission with neurological im­pairment.

This case demonstrates that the spot sign in ASDH might be useful in the prediction of hematoma expansion.