Spontaneous resolution of chronic subdural hematoma

BACKGROUND Spontaneous resolution of chronic subdural hematoma has rarely b een reported in the literature, and its mechanism has not been fully invest igated. Response to surgery has been very satisfactory; in fact, this is ge nerally considered the treatment of choice. METHODS From a series of 24 cases of chronic subdural hematomas, we observe d five patients between 1996 to 1998. These patients showed headache and de crease of cognitive level, 4-5 weeks after minor head injury. Neurologic ev aluation revealed only worsening of mental function according to Mini Menta l State Examination (MMSE). Computed tomography (CT) scans showed brain atr ophy and chronic subdural hematoma without increased intracranial pressure. These patients were treated by clinical observation and serial cerebral CT scans. RESULTS After 7 to 10 days, all patients showed improvement of clinical sig ns. After 30 to 45 days, radiological disappearance or marked reduction in size of the hematoma and complete clinical recovery were obtained. No neuro logical deficits and no recurrences have been observed during follow-up (3 months to 2 years). CONCLUSIONS We believe that age greater than 70 years, decreased cognitive level (MMSE = 21), brain atrophy, and absence of increase of intracranial p ressure are clinical and radiological signs that allow one to choose conser vative treatment. (C) 2000 by Elsevier Science Inc.