Traumatic brain injury (TBI) is defined as impaired brain function due to external force. In the adult population threated at the Emergency Department (ED) prevalence is twice as high in males then females. It is classified as mild moderate and severe based on Glasgow Coma Scale (GCS). Subdural Hematomas (SDH) are generally associated with high-energy traumas, especially road accidents and mostly seen amongst the population aged <50 years. SDH also tends to collect more slowly than epidural hematoma. Traditionally after two weeks the term chronic SH is used. Chronic SDH affects mostly the elderly, and it is one of the most common disorders seen in neurosurgical practice. Computerized tomography (CT) based imaging is the primary method of choice and allows detection of a SDH in clinically suspected cases with a near 100% sensitivity. A 37-year-old female presented to our ED with persistent headache in the last one month. She has a history of a fall from a scooter and denies any other trauma. She has been complaining of severe headaches associated with nausea and dizziness and recently she started to feel some weakness in the lower limbs while she is walking. She had been to another facility and undergone magnetic resonance imaging for the brain and advised to seek neurosurgery follow up for brain hemorrhage. She denies any chronic diseases and medication. Neurological examination revealed only brisk reflexes and bilateral positive Babinski. Other system evaluation, laboratory results and vitals were within normal range. Head CT was ordered from the ED and revealed the presence of bilateral frontoparietal subacute subdural hematoma, without mass-effect or midline shift. No definite evidence of intra-axial lesions or recent blood collection. Bone window images show no definite evidence of depressed or displaced fractures. She was admitted and underwent surgery for SDH. Headache after trauma is an indicative finding for CT imaging at the ED according to New Orleans Criteria clinical decision rules for TBI. SDHs of a traumatic nature affect men more than women and as a young female with persistent headache our patient was not a typical chronic SDH case for the ED. She also decided to seek medical attention after some additional neurological symptoms and more than a month after her initial trauma. Although she was not a typical acute TBI case, emergency physicians should be aware of the persistent symptoms especially headache and any additional findings after a trauma. Detailed history is important for proper management of the patients. In the literature, spontaneous resolution of CSDH has rarely been reported. It is even more rare if the subdural hematoma is bilateral. Age, trauma mechanism, morphology of the hematoma, perioperative GCS score, signs of cerebral edema, and timing between trauma and surgical therapy are relevant factors for the prognosis. The primary ED management objective for TBI is to identify patients that require neurosurgical intervention. Head CT must be taken as soon as possible, and patients should be operated upon urgently if there is an indication for surgery.

Keywords: Traumatic brain injury, subdural hematoma, headache.