Cerebral Hyperperfusion and Delayed Coma Recovery after Subdural Hematoma Evacuation

Ibrahim Migdady, Patrick Chen, Alejandra Márquez Loza, Christopher R. Cashman, Saef Izzy

Research output: Contribution to journalArticlepeer-review


Acute subdural hematoma is a devastating neurological injury with significant morbidity and mortality. In patients with large subdural hematoma resulting in compression of the underlying brain and lateral brain shift, severe neurological deficits and coma can occur. Emergent neurosurgical decompression is a life-saving intervention which improves mortality and neurological function. Persistent coma despite subdural hematoma evacuation is often the result of persistent midline shift, cerebral infarctions related to initial elevated intracranial pressure and herniation, nonconvulsive seizures, and other metabolic and infectious causes; however, a subset of patients remains comatose without a discernable etiology. In this report, we describe an elderly patient who remained comatose without a known cause for several weeks after subdural hematoma evacuation and was found to have delayed cerebral hyperperfusion on brain imaging. After several days, there was marked recovery of consciousness which occurred in a timeframe that matched improvement in brain imaging findings. Cerebral hyperperfusion following subdural hematoma evacuation requires further investigation, and should be considered as a cause of persistent but potentially recoverable coma.

Original languageEnglish (US)
Article number106165
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number12
StatePublished - Dec 2021
Externally publishedYes


  • Cerebral hypoperfusion
  • Coma recovery
  • Craniectomy
  • Subdural hematoma

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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