Spontaneous intracranial hypotension resulting in coma: case report.
OBJECTIVE
Spontaneous intracranial hypotension is a potentially severe condition characterized by a distinct clinical picture caused by low cerebrospinal fluid pressure. Although coma has been reported previously as a presentation of this condition, this is the first report in which misdiagnosis of this condition and unwarranted surgery led to coma.


METHODS
A 62-year-old man presented with a history of headache, and cranial magnetic resonance imaging showed bilateral chronic subdural hematomas. After evacuation of the hematoma, the patient's condition deteriorated into a state of profound depression of consciousness. Repeated cranial computed tomographic scans showed intracranial air, and intracranial pressure monitoring showed negative recording. Spinal magnetic resonance imaging demonstrated epidural cerebrospinal fluid leaks at the middle and lower thoracic levels.


METHODS
Epidural blood patch resulted in almost immediate improvement in the patient's condition, and he was fully awake 24 hours later.


CONCLUSIONS
This case report expands the presently known clinical spectrum of this uncommon and generally benign illness.
Sayer
Faisal T
FT
Department of Neurosurgery, Lund University Hospital, Lund, Sweden. Faisal.Sayer@neurokir.lu.se
Bodelsson
Mikael
M
Larsson
Elna-Marie
EM
Romner
Bertil
B
D017217:Blood Patch, Epidural; D002908:Chronic Disease; D003128:Coma / Q000209:etiology*; D003951:Diagnostic Errors; D006408:Hematoma, Subdural / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D019585:Intracranial Hypotension / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D013353:Subdural Effusion / Q000209:etiology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures / Q000009:adverse effects*