Journal of Korean Society of Geriatric Neurosurgery 2013;9(1):53-57.
Published online June 30, 2013.
Therapeutic Strategy of Spontaneous Intracranial Hypotension in Patients with Bilateral Subacute Subdural Hematoma
Eui-Gyu Sin1 , Cheol-Young Lee1,2 , Ho-Gyun Ha1 , Chul-Ku Jung1
1Department of Neurosurgery, Konyang University School of Medicine, Daejon, Korea 2Graduate School of Medicine, Kyung-Hee University School of Medicine, Seoul, Korea
Abstract
Spontaneous intracranial hypotension (SIH) in patient with bilateral subacute subdural hematoma is not a well recognized concept in the neurosurgical field. Thus, in patients with spontaneous intracranial hypotension and concurrent subdural hematomas (SDH), SIH is frequently not recognized. If only the SDH is addressed without management of SIH, the SIH may cause frequent recurrence or other disastrous consequences. A 40-year-old female visited our clinic for intermittent headache while changing her position. She had no traumatic brain injury and brain computed tomography (CT) scan showed bilateral subacute SDH and brain magnetic resonance image (MRI) with enhancement demonstrated diffuse pachymeningeal enhancement. Thus she was diagnosed with a bilateral subdural hematomas caused by spontaneous intracranial hypotension. To our knowledge there is no obvious guideline for the treatment of concurrent SDH and SIH. The authors report a case presenting with CSF leakage of unidentified cause with concurrent bilateral subacute SDH which was revealed to have been caused by SIH. Epidural blood patch was introduced to the presumed CSF leakage site resulting in complete resolution of SDH and good clinical result.
Key Words: Subdural hematomaㆍSpontaneous intracranial hypotensionㆍHeadacheㆍCSF leakageㆍIntracranial pressure


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