Non-traumatic subdural hematoma in a third-trimester gravid patient: A case report

Abstract Background Subdural hematoma (SDH) is often due to the rupture of bridging veins following a traumatic brain injury. Non-traumatic SDH is less common and often due to arterial rupture following the rupture of cerebral aneurysms and arteriovenous fistulae, coagulation disorders, or brain tumors. Non-traumatic SDH is rarer in pregnancy. In this article, the authors report on a case of non-traumatic SDH in pregnancy. Case description A 41-year-old G4P4 black female in her 36th week of pregnancy and no relevant past medical or surgical history presented a moderate headache that had begun six days before the consultation. The headache was associated with a low-grade fever. Routine lab tests were normal except for a positive blood smear (750 Plasmodium falciparum/mm3). The patient received intravenous artesunate for malaria in pregnancy, but on the second day of her treatment, she developed altered mental status and projectile vomiting. A non-contrast head CT scan revealed a left acute-on-chronic subdural hematoma with subfalcine engagement, and the fetal well-being was satisfactory on ultrasonography. An emergency cesarean section and a left burr hole SDH evacuation were performed. The postoperative suites were unremarkable - the mother recovered completely, and the newborn was healthy at discharge. Conclusion Non-traumatic SDH is a rare condition that should be diagnosed early and managed by a specialized and multidisciplinary team.