Acute fatal delayed subdural hemorrhage diagnosed with head computed tomography scan 19 days after hospital admission: A case report

Delayed acute traumatic subdural hematoma (SDH) refers to an acute SDH that develops after an initially normal head computed tomography (CT) scan in a trauma patient. Although uncommon, it occurs more often in elderly patients and in those receiving anticoagulation therapy. However, current traumatic brain injury monitoring guidelines may not always account for delayed intracranial bleeding in younger patients without typical risk factors. We report a 42-year-old male involved in a motor vehicle collision. The initial CT images demonstrated chest injuries and a normal head CT. The patient was not receiving anticoagulant or antiplatelet therapy. While recovering from his traumatic injuries, on hospital day nineteen, he acutely deteriorated and was found to have a large acute SDH. Despite emergent decompressive craniectomy and hematoma evacuation, the patient died. This case highlights that a normal head CT in trauma patients on admission does not exclude the possibility of a subsequent catastrophic intracranial hemorrhage. Such unpredictable consequences may occur days or weeks after an apparent clinical recovery.