[An elderly patient with traumatic acute subdural hematoma who "talked and deteriorated"]

A 62-year-old man was transferred to our hospital 20 min after a motor vehicle accident. The CT scan on admission revealed mixed density area of acute subdural hematoma, but he was asymptomatic on physical examination. Course observation without brain edema therapy resulted in severe disturbance of consciousness 2 hours after the traffic accident. The CT scan at this time showed the enlargement of the hematoma, and midline shift. Emergent external decompression was performed 4 hours after the head trauma, but he died of heart failure on the 8 th day after the operation. We consider that the important factors for saving this patient were rapid diagnosis by repeated CT scan and conservative brain edema therapy early in the post-traumatic period.