Spontaneous chronic subdural hematoma in a 22-year-old healthy woman

Chronic subdural hematoma is a common presentation to the neurosurgical practice that tends to occur among the elderly.

We identify a rare occurrence of a chronic subdural hematoma in a young and otherwise healthy female patient who denied a traumatic brain injury.

Upon reviewing the literature, we found only one reported case of a spontaneous nature in a young patient. The subtle presentation of headaches and absence of neurological deficit could be mistaken as migraine and result in a delay in obtaining imaging and necessary treatment. In this report, we present a 22-year-old patient who complained of persistent headaches and was neurologically intact on examination. Cranial computed tomography revealed the presence of a right-sided chronic subdural hematoma; this was followed by magnetic resonance imaging plus angiogram, which ruled out the presence of a vascular abnormality. A burr-hole craniostomy procedure was used that resulted in resolution of symptoms.

Without a heightened clinical suspicion, a similar presentation could be missed, resulting in delayed management.