title: Spontaneous intracranial hypotension resulting in coma: case report.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Lund University Hospital, Lund, Sweden. Faisal.Sayer@neurokir.lu.se
authors.forename: Faisal T
authors.initials: FT
authors.lastname: Sayer
authors.forename: Mikael
authors.initials: M
authors.lastname: Bodelsson
authors.forename: Elna-Marie
authors.initials: EM
authors.lastname: Larsson
authors.forename: Bertil
authors.initials: B
authors.lastname: Romner
mesh_terms: 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*