Abstract
Severe acute subdural hematoma (ASDH) secondary to human parvovirus B19 (B19V) infection is exceptionally rare in adults and presents unique neurocritical care challenges. We report a previously healthy 35-year-old woman with a history of two cesarean sections and no chronic diseases, who developed a sudden headache followed by rapid neurological deterioration. Head computed tomography (CT) revealed a massive right fronto-temporo-parietal ASDH with marked midline shift. Notably, one week prior to admission, she traveled to Guangzhou with her children, two of whom developed fever three days and confirmed B19V infection before her symptoms, suggesting possible household transmission. The association between ASDH and B19V infection was established by excluding other common causes (such as trauma, vascular malformations, coagulopathies, and other infections) through detailed history, imaging, and laboratory investigations. The association between ASDH and B19V infection was established by: (1) exclusion of other common etiologies (trauma, vascular malformations, coagulopathies, and other infections) through detailed history, imaging, and laboratory investigations; (2) confirmation of acute B19V infection by serological and molecular testing; (3) clear temporal relationship with household exposure. Emergency hematoma evacuation and decompressive craniectomy were performed. Specialized neurocritical nursing included automated quantitative pupillometry for early detection of intracranial hypertension, and strict hemodynamic control, with continuous arterial blood pressure monitoring and antihypertensive therapy to maintain systolic blood pressure within 110-130mmHg, minimizing the risk of rebleeding and further neurological injury. Ultra-early rehabilitation was initiated. Immediate postoperative extubation was deferred due to the timing of surgery (early morning), limited night staffing, and the need for close postoperative neurological and respiratory monitoring. The patient was safely weaned from mechanical ventilation on postoperative day 1 after confirming stable neurological and respiratory function. Muscle strength was evaluated using the manual muscle testing (MMT) scale, which improved to grade IV in all limbs. She was transferred for rehabilitation on postoperative day 23. To our knowledge, this represents one of the first reports of favorable neurological recovery in an adult with life-threatening B19V-associated intracranial hemorrhage. This case demonstrates that rapid surgical intervention combined with monitoring, targeted infection control, and intensive early rehabilitation can achieve favorable outcomes in this exceedingly rare condition.