Recurrence of spontaneous intracranial hypotension with subdural hematomas.
A 59-year-old man developed postural headache associated with a low CSF pressure. A CT scan revealed no abnormal findings and the orthostatic symptoms resolved without treatment 6 weeks after onset. He was diagnosed as having spontaneous intracranial hypotension (SIH) and remained symptom-free until he experienced recurrence of postural headache 9 months later. A lumbar puncture demonstrated low CSF pressure, and a CT scan revealed slit-like ventricles with narrowing of the sulci, Sylvian fissures, and infratentorial cisterns, in addition to bilateral subdural masses. After draining the hematomas, his symptoms resolved completely, and a follow-up CT scan was normal. We hypothesize that recurrent SIH in this case was due to small recurrent tears of a root sleeve. This case emphasizes the importance of follow-up of SIH for at least 9 months after resolution of symptoms.
Sato
Y
Y
First Department of Internal Medicine, Kurume University School of Medicine, Japan.
Honda
Y
Y
Maruoka
H
H
Fujimatsu
Y
Y
Oizumi
K
K
D001921:Brain / Q000000981:diagnostic imaging; D006261:Headache / Q000000981:diagnostic imaging / Q000209:etiology*; D006408:Hematoma, Subdural / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D007022:Hypotension; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014057:Tomography, X-Ray Computed