Nontraumatic Spontaneous Acute Subdural Hematoma in Identical Teenage Twins 1 Year Apart

OBJECTIVES:Acute subdural hematoma (ASDH) is a life-threatening injury with a high mortality rate. Most ASDH cases are a result of trauma; nontraumatic causes are relatively rare with an incidence rate of 3% to 5%. We report an unusual series of 2 patients, identical twins, who had nontraumatic subdural hematomas 1 year apart, one at age 15 and the other at age 16. METHODS (CASE PRESENTATIONS):Identical twin brothers presented 1 year and 10 days apart to an academic medical center after incurring confusion, decreased mental functioning, and a subsequent comatose state. The injuries occurred while the patients were playing football, but there was no evidence of traumatic blow to the head in either brother. RESULTS:Both patients had computed tomographic scans and both underwent emergency surgery for hematoma evacuation. Both patients recovered full neurological function and remained healthy 12 years after surgery. CONCLUSIONS:Acute spontaneous subdural hematoma is an emergent medical condition that may result in rapid neurological decline and must be addressed in a timely fashion. After evacuation of the hematoma, intracranial pressure decreases and cerebral perfusion pressure increases, which may allow normal perfusion of the brain. Consequently, prompt recognition and evacuation of an ASDH can drastically improve prognosis. Rarely, subdural hematoma can occur without head injury and should be in the differential diagnosis of athletes who rapidly become comatose.