Rapid spontaneous migration and resolution of an acute subdural hematoma: A case report and comprehensive literature review

This case report details a 32-year-old male with a known history of seizures who presented with an acute subdural hematoma (SDH) after a low-energy, low-velocity head injury, giving the impression of a relatively minor trauma mechanism. Although his initial Glasgow Coma Scale (GCS) score was 7, the depressed level of consciousness was considered disproportionate to the imaging findings and potentially related to a postictal state. Interestingly, the hematoma, after initially affecting the cranial region, later migrated to the lumbar spine, precipitating cauda equina syndrome. Remarkably, through conservative management and without the need for surgical intervention, the patient recovered fully. This case presents the rare phenomenon of hematoma migration and emphasizes the importance of distinguishing between subdural hematoma and hematohygroma. Moreover, it discusses the decision-making process in avoiding surgery, based on the suspicion of a seizure-related postictal coma. A detailed review of the literature, particularly cases involving similar migration, is also presented, exploring both surgical and conservative approaches to treatment.