Spontaneous Resolution of Acute Epidural Hematoma with a Good Clinical Outcome

Resolução Espontânea de Hematoma Epidural Agudo com Bom Resultado Clínico

• Carlos Umberto Pereira    
• Paulo Roberto Santos Mendonça    
• Marcelo Barreto Barbosa    
• Antonio Carlos Silveira Azevedo    
• Ana Flavia Pereira Beiritz Pinto    
• Samuel Pedro Pereira Silveira    

• https://doi.org/10.22290/jbnc.2026.08121541
• J Bras Neurocirur 37 (1):129-134, 2026

Resumo

Introdução: O hematoma epidural intracraniano (HEI) é considerado uma emergência neurocirúrgica. Em casos selecionados pode ser submetido a tratamento conservador. Resolução espontânea tem sido rara. Caso 1: Paciente com 19 anos, masculino. Vítima de acidente trânsito. Tomografia de crânio apresentou HEI agudo na região parietal esquerda, sendo submetido a tratamento conservador. Apresentou reabsorção espontânea dentro de sete horas, com boa evolução clínica. Caso 2: paciente com 11 meses de idade, masculino. Queda acidental. Atendida com irritabilidade, choro e um episódio de vomito. TC crânio sem contraste: hematoma subgaleal parietal esquerdo, fratura parietal esquerda, hematoma epidural parietal esquerdo e hematoma intraparenquimatoso adjacente a fratura. Tratamento conservador, nove horas depois novo TC crânio revelou hematoma subgaleal parietal esquerdo, redução hematoma intraparenquimatoso e ausência do HEI. Alta medica sem déficit neurológico evidente. Conclusão: A reabsorção espontânea do HEI agudo tem sido raro em casos de tratamento conservador. As hipóteses sobre a reabsorção do hematoma não estão ainda esclarecidas. Em caso de reabsorção espontânea cursa com bom prognóstico.

Palavras-chave

Hematoma epidural; Traumatismo cranioencefálico; Fratura craniana; Resolução espontânea

Abstract

Introduction: Intracranial epidural hematoma (IEH) is considered a neurosurgical emergency. In selected cases, it may be subjected to conservative treatment. Spontaneous resolution has been rare. Case 1: 19-year-old male patient. Traffic accident victim. Skull tomography showed acute IEH in the left parietal region, and he was subjected to conservative treatment. The patient presented spontaneous reabsorption within seven hours, with good clinical evolution. Case 2: 11-month-old male patient. Accidental fall. Presented with irritability, crying, and one episode of vomiting. Non-contrast skull CT: left parietal subgaleal hematoma, left parietal fracture, left parietal epidural hematoma, and intraparenchymal hematoma adjacent to the fracture. Conservative treatment was chosen. Nine hours later, a new skull CT revealed left parietal subgaleal hematoma, reduction of the intraparenchymal hematoma, and absence of the IEH. Medical discharge without evident neurological deficit. Conclusion: Spontaneous reabsorption of acute IEH has been rare in cases of conservative treatment. The hypotheses about hematoma reabsorption are not yet clarified. In cases of spontaneous reabsorption, the prognosis is good.

Keywords

Epidural hematoma; Head trauma; Skull fracture; Spontaneous resolution

References

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The formation of fibrovascular neomembrane or granulation tissue is particularly considered to be the resolution mechanism in chronic IEH due to the time period necessary for its formation10. The IEH reabsorption mechanism can be compared to that of CSDH15. The formation of fibrovascular neomembrane located pressure; pressure developed within the blood collection volume, aiming at bleeding tamponade; and pressure exerted by the lesion, such as intracranial EH. The extracranial space presents no resistance; therefore, from the diastatic fracture line, unilateral conduction of blood volume will occur, reducing the intracranial amount of the lesion and increasing the subgaleal hematoma7. Aydemir et al. reported a case in which the patient presented EH associated with subgaleal hematoma, citing that spontaneous resolution of the first entity occurred due to pressure difference between the epicranial and epidural spaces, connected via cranial fracture, in which cerebral pulsations conducted the epidural blood collection to the epicranial region1.

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Carlos Umberto Pereira, MD, PhD

Neurosurgeon

Hospital de Urgência de Sergipe – HUSE

Neurosurgery Service

Aracaju, Sergipe, Brasil

E-mail: umberto@infonet.com.br

Funding: nothing to disclose.

Conflicts of interest: nothing to disclose.

PMid:23708934.

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1Neurosurgery Service, Hospital de Urgência de Sergipe – HUSE, Aracaju, SE, Brasil.

2.Universidade Tiradentes, Aracaju, SE, Brasil.

3.Universidade Federal do Triângulo Mineiro – UFTM. Uberaba, MG, Brasil.

 

Received Aug 11, 2025

Accepted Aug 26, 2025