title: [Refractory chronic subdural hematoma due to spontaneous intracranial hypotension].
abstract: Spontaneous intracranial hypotension (SIH) is reported to cause chronic subdurai hematoma (SDH), however diagnosis of SIH in patients with SDH is not always easy. We report a case of chronic SDH refractory to repeated drainage, which was attributed to SIH. A forty-five-year-old man who had been suffering from orthostatic headache for one month was admitted to our hospital presenting with unconsciousness and hemiparesis. CT on admission revealed a chronic subdural hematoma, which was successfully treated once with subdural drainage. However, the patient fell into unconscious again with recurrence of the hematoma within several days. After two more sessions of drainage, SIH due to cerebrospinal fluid leakage was diagnosed with spinal magnetic resonance imaging (MRI) and radionuclide cisternography. Spinal MRI demonstrated abnormal fluid accumulation in the thoracic epidural space, and the radionuclide cisternogram showed early excretion of tracer into urine as well as absence of intracranial tracer filling. After treatment with epidural blood patching, the hematoma rapidly disappeared and he was discharged without symptoms. In the treatment of chronic SDH, especially in young to middle aged patient without preceding trauma or hematological disorders, physicians should pay attention to underlying SIH to avoid multiple surgery. MRI of the spine as well as radionuclide cisternography is useful in evaluation of this condition.
authors: Department of Neurosurgery, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan.
authors: Teruo
authors: T
authors: Takahashi
authors: Nobuo
authors: N
authors: Senbokuya
authors: Toru
authors: T
authors: Horikoshi
authors: Eiji
authors: E
authors: Sato
authors: Hideaki
authors: H
authors: Nukui
authors: Hiroyuki
authors: H
authors: Kinouchi
mesh_terms: D017217:Blood Patch, Epidural; D004322:Drainage; D020200:Hematoma, Subdural, Chronic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D019585:Intracranial Hypotension / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009192:Myelography; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome