Spontaneous Subdural Hematoma in a Healthy 28-Year-Old Male During Latissimus Dorsi Pulldowns: A Case Report

Non-traumatic subdural hematomas (SDHs) in healthy, young individuals are rare, with strenuous physical activity occasionally implicated. We present such a case in a 28-year-old male with no pertinent past medical, surgical, or family history. The patient presented to the emergency department six days after he was performing latissimus dorsi pulldowns during a workout at approximately 3:00 AM when he experienced a sudden "pop" sensation in his head followed by transient loss of vision in his left eye for 20 minutes, dizziness, and nausea. The symptoms temporarily improved enough for him to drive home. However, he developed a persistent headache, nausea, and intermittent vomiting over the subsequent days. On day 6, intractable vomiting and persistent dizziness prompted emergency department evaluation. Initial non-contrast computed tomography (CT) of the head revealed an 8-mm left frontoparietal SDH, while CT angiography was unremarkable. He reported dehydration and consumption of a high-caffeine energy drink before his workout. He denied recreational or performance-enhancing drug use or trauma. He underwent left-sided craniotomy with SDH evacuation and subdural drain placement. Postoperative imaging confirmed hematoma evacuation and improved midline shift. Apart from transient confusion on postoperative day 3, his recovery was uneventful and he was discharged on postoperative day 5. He reported complete resolution of symptoms at a two-week follow-up. We review the available literature regarding non-traumatic SDHs and speculate the cause of SDH in our case.