BACKGROUND Acute, recurrent subdural hematoma (SDH) is a rare entity in the absence of trauma. Atraumatic SDH may be due to vascular disorders, coagulopathies, or intracranial hypotension. It is a rare complication of disseminated intravascular coagulation (DIC), with no prior reports in patients with intracranial metastatic colon cancer (MCC). Rapid resolution of the initial acute SDH with contralateral recurrence has not yet been reported in the literature. We present a case of rapidly resolving and recurrent, contralateral acute SDH from DIC secondary to MCC. CASE DESCRIPTION A 77-year-old woman with MCC presented with severe, acute onset headache. She progressed to unresponsiveness, dilated right pupil, and Glasgow Coma Scale (GCS) score of 4T. Initial computed tomography (CT) of the head demonstrated a right, 17-mm SDH with a right-to-left midline shift. Repeat CT head 8 hours later revealed resolution of the right SDH. She was extubated with notable clinical improvement. Laboratory examination showed international normalized ratio of 3.4, leukocytosis, and thrombocytopenia. The next morning, she became lethargic, GCS score of 3, with bilateral fixed pupils and dilated to 5-mm, and she was then reintubated. Repeat CT head demonstrated a new left SDH with bilateral uncal herniation. A small hyperdense focus in the left parietal region was suspicious for intraparenchymal hematoma versus a hemorrhagic metastatic focus. Shortly after, she was extubated due to do not resuscitate status, and she then passed away. CONCLUSIONS To our knowledge, this is the first case illustrating rapidly resolving and recurrent, contralateral acute SDH from DIC in a patient with MCC. Clinical recognition of this phenotypic pattern should raise the question of an underlying coagulopathy.

中文翻译：

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从弥散性血管内凝血快速解决和复发对侧硬脑膜下血肿。

背景技术在没有创伤的情况下，急性复发性硬脑膜下血肿（SDH）是一种罕见的实体。无创伤性SDH可能是由于血管疾病，凝血病或颅内低血压引起的。它是弥散性血管内凝血（DIC）的罕见并发症，颅内转移性结肠癌（MCC）患者之前没有报道。尚未有文献报道对对侧复发的急性急性SDH的快速解决方法。我们提出了一个快速解决且复发的对侧继发于MCC的DIC对侧急性SDH的病例。病例描述一名77岁的MCC患者出现严重的急性发作性头痛。她进展为无反应，右瞳孔散大，格拉斯哥昏迷评分（GCS）得分为4T。头部的初步计算机体层摄影（CT）显示正确，17毫米SDH，中线左右偏移。8小时后重复CT头部检查，显示正确的SDH分辨率。她的拔管得到了明显的临床改善。实验室检查显示国际标准化比率为3.4，白细胞增多症和血小板减少症。第二天早上，她变得昏昏欲睡，GCS评分为3，双侧固定瞳孔扩大到5毫米，然后重新插管。重复CT头表现为新的左SDH伴双侧非标状疝。实质内血肿与出血性转移灶相比，左顶叶区域有一个小的高密度灶。不久之后，她因没有恢复生命状态而被拔管，然后她去世了。结论据我们所知，这是第一个说明快速解决和反复出现的情况，MCC患者的DIC对侧急性SDH。这种表型的临床认识应引起潜在的凝血病的问题。