Survival of a patient with an acute traumatic subdural hematoma and high-grade liver injury with associated IVC injury without surgical intervention

Abstract

Blunt trauma can often result in multi-organ injury. Traumatic brain injury with significant intracranial hemorrhage is usually addressed with surgical intervention to prevent further injury, particularly in the presence of midline shift. Concurrent liver injury and hemorrhage can present challenges in management. Here, we discuss the case of a 46-year-old male who presented after a motor vehicle crash and was found to have a subdural hematoma (SDH) with midline shift and herniation, which was determined to be non-survivable by neurosurgery. On cross-sectional imaging, the patient was additionally found to have a Grade V liver injury with extension into the inferior vena cava. No surgical interventions were performed for the intracranial hemorrhage or intra-abdominal injuries. The patient did not succumb to these injuries, but had a decrease in the size of the intracranial hemorrhage, and eventually regained consciousness during the hospital course, surviving to discharge.