2020 年 43 巻 1 号 p. 13-16
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.