Spontaneous ultra-early resorption of an intracerebral hematoma in a cirrhotic patient: case report and analysis of this unusual phenomenon

Spontaneous intracranial hemorrhage (ICH) is the second most common form of stroke and represents a life-threatening neurological emergency. The clinical course of an intracerebral hematoma varies widely, ranging from stable clot containment to progressive hematoma expansion with resulting neurological deterioration and increased mortality. Conversely, rapid resorption of acute hematomas is an uncommon phenomenon that typically unfolds over several days. The association between cirrhosis and spontaneous ICH remains controversial, and the factors influencing hematoma evolution in cirrhotic patients are poorly understood. We present the case of a 41-year-old man with a history of liver cirrhosis, chronic alcohol use, and occasional cocaine abuse, who arrived with a sudden severe headache, vomiting, and a Glasgow Coma Scale score of 12. Imaging revealed a large spontaneous left temporo-parietal intraparenchymal hemorrhage, which was managed conservatively. Remarkably, a follow-up CT scan performed 20 h after symptom onset demonstrated complete resolution of the hematoma without surgical intervention. A systematic review of the literature was conducted to explore potential pathophysiological mechanisms underlying this rare and rapid hematoma resorption. To the authors' knowledge, this represents the first documented case of ultra-early spontaneous resolution of ICH, both in the general population and specifically in a patient with cirrhosis. We hypothesize that this phenomenon may reflect a complex interplay between cirrhosis-associated coagulopathy and alterations in the fibrinolytic system, suggesting novel insights into ICH pathophysiology that could inform future therapeutic approaches. Further research is warranted to validate these findings and elucidate underlying mechanisms.