Acute subdural hematoma in a high school football player

A 16-year-old football player developed a headache following a collision during a game. When his headache persisted for 1 week, he underwent a computerized tomographic (CT) scan to determine the cause. Findings were normal and a concussion was diagnosed. Seventeen days after the injury, the athlete reported disappearance of his symptoms. Provocative testing failed to recreate symptoms. The athlete continued to deny any symptoms and was cleared for unlimited participation 30 days after the initial injury. In the next game, the athlete collided with an opposing player, ran to the sidelines, and deteriorated on the sidelines after complaining of dizziness. Local Emergency Medical Squad personnel intubated him and transported him to a local hospital emergency room. Attending neurosurgeons diagnosed a right subdural hematoma by CT scan. A burr hole craniotomy evacuated the lesion. The operative report noted a second area of chronic membrane formation consistent with past head trauma. This lesion had escaped detection on two CT scans. In an interview 4 months postoperatively, the athlete admitted having experienced constant symptoms between the first and second injuries.