Intracranial subdural hematoma coexisting with improvement in spontaneous intracranial hypotension after an epidural blood patch

Cheng Hsi Chang, Jau Ching Wu, Tsung Hsi Tu, Hung Chieh Chen, Wen Cheng Huang, Shu Shya Hseu, Jiing Feng Lirng, Shuu Jiun Wang, Henrich Cheng, Chin Chu Ko*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

A 36-year-old male had spontaneous intracranial hypotension (SIH) presenting with refractory headache for 4 months. Multiple epidural blood patches (EBPs) yielded relief of symptoms, but the course was complicated, with asymptomatic intracranial subdural hematoma (SDH). Except for SDH, other radiological diagnostic signs of SIH were resolved and the patient's headaches improved after EBP. Owing to a mass effect and persistent cerebrospinal fluid (CSF) leakage, surgical repair of the spinal leakage was performed, but no cranial procedures were carried out. Postoperatively, the SDH completely resolved, but there was still CSF leakage at the level where surgery was performed. The patient has remained free of headache or other events for 3 years. It was reduction rather than elimination of the spinal CSF leak that yielded remission of SIH. In summary, intracranial SDH can be a complication of inadequately treated SIH (i.e. persistent minor CSF leakage). Management of SDH should focus on correction of the underlying SIH rather than craniotomy for hematoma evacuation.

Original languageEnglish
Pages (from-to)610-613
Number of pages4
JournalJournal of the Chinese Medical Association
Volume75
Issue number11
DOIs
StatePublished - Nov 2012

Keywords

  • Epidural blood patch
  • Spontaneous intracranial hypotension
  • Spontaneous spinal cerebrospinal fluid leaks
  • Subdural hematoma
  • Surgical repair

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