Puplished on: April 2025
In many parts of the world, access to advanced neurosurgical care remains limited. However, even in such settings, careful clinical judgment and basic medical support can result in remarkable outcomes. This case highlights the successful conservative (non-surgical) management of a 50-year-old man who sustained an acute subdural hematoma (SDH) following a road traffic accident.
A 50-year-old man, Farhaan, was struck by a vehicle while walking along the side of a road. He was brought to our emergency department with semi-consciousness (GCS 10) and visible lacerations on the forehead with minor bleeding. Upon arrival, the patient was hemodynamically stable with normal blood pressure. However, his body temperature was recorded at 26°C, likely due to environmental exposure prior to hospital admission.
Due to the absence of a CT scanner in our facility, we ordered an MRI scan, which revealed an acute subdural hematoma. In the absence of neurosurgical resources and with the patient remaining relatively stable, we decided to proceed with conservative management under close observation.
Treatment Protocol
The patient received the following treatment regimen over five days:
- Normal Saline 0.9% – 500 ml twice daily
- Ceftriaxone 1g IV – Twice daily for 5 days
- Dexamethasone 4mg IV – Twice daily for 3 days
- Mannitol – Once daily for 2 days
- Paracetamol infusion – As needed for pain or fever
- Omeprazole IV – To prevent gastrointestinal irritation
Clinical Progress & Outcome
By the end of the fifth day, the patient showed significant clinical improvement, regaining full consciousness and neurological stability. A repeat MRI scan confirmed that the subdural hematoma had significantly regressed. The patient was discharged in stable condition, with full recovery expected
After 5 days of treatment we re-scanned the patient
Caption: MRI on admission showing acute subdural hematoma (above), and follow-up MRI after conservative management (below). Hematoma has significantly resolved.
Discussion
This case underscores the potential for non-surgical management of selected cases of acute SDH, especially when:
- The patient remains hemodynamically stable
- There is no significant midline shift or brain herniation
- Neurosurgical intervention is unavailable
While surgery remains the gold standard for most acute SDH cases with mass effect or deterioration, this case provides evidence that conservative management can be a viable alternative in carefully monitored cases.
This rare case of acute subdural hematoma treated without surgical intervention highlights the importance of clinical judgment, timely imaging, and supportive care, especially in low-resource settings. Such cases serve as a reminder that hope and healing can still be achieved, even with limited tools.
This case is shared for educational purposes only. All patient identifiers have been removed to preserve privacy. Management decisions should be made on a case-by-case basis under appropriate clinical supervision.