Acute subdural hematoma after a reported mild concussion: a case report

J Athl Train. 1998 Jul;33(3):264-8.


Objective: This case details the possible relationship between a reported mild concussion and an acute subdural hematoma in a football athlete. Concussion grading scales and return-to-play guidelines are also discussed.

Background: An otherwise healthy athlete suffered a re- ported mild concussion, and continued symptoms led to the diagnosis of postconcussion syndrome. The patient returned to football 25 days after the injury and sustained a second head injury 10 days later. He became unconscious and presented with decerebrate posturing, a fixed and dilated left pupil, shallow breathing, right-sided paralysis, and bilateral Babinski signs.

Differential diagnosis: Possible pathologies included subdural hematoma, epidural hematoma, cerebrovascular accident, cerebral edema, and intracerebral hemorrhage.

Treatment: Computerized tomography indicated fluid overlying the left hemisphere and temporal fossa. Two burr holes released acute and clotted subdural blood. After 19 days, the patient was discharged without neurologic deficit.

Uniqueness: Traditionally, acute subdural hematomas are thought to result from single traumatic incidents. However, individuals may be more susceptible to such pathology after recent head trauma.

Conclusions: Recent mild head injury may increase the risk for catastrophic pathology. This case emphasizes the importance of using concussion grading scales and adhering to return-to-play guidelines, as well as the use of additional diagnostic techniques after mild head Injury.