Delayed-onset subdural hematoma after mild head injury with negative initial brain imaging

Area of Science:

• Neurosurgery
• Neurology
• Radiology

Background:

• Mild head injuries are frequent in emergency settings.
• Standard protocol involves discharge if mental status is good and initial CT scans are normal.
• Delayed complications after mild head trauma are uncommon but possible.

Observation:

• An 82-year-old male presented with delayed symptoms five weeks post-mild head injury.
• Initial CT and MR imaging showed no abnormalities.
• The patient later developed severe headaches and ataxic gait.

Findings:

• Brain CT revealed delayed-onset bilateral subdural hematoma.
• The hematoma caused significant compression of lateral ventricles and a midline shift.
• The patient was not on anticoagulant or antiplatelet medication.

Implications:

• This case underscores the possibility of rare delayed complications after mild head trauma.
• It suggests the need for vigilance and potential follow-up imaging in specific patient groups.
• Understanding pathophysiological mechanisms is crucial for managing such uncommon presentations.