title: Intracranial subdural hematoma coexisting with improvement in spontaneous intracranial hypotension after an epidural blood patch.
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.
authors.affiliation: Department of Anesthesiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC.
authors.forename: Cheng-Hsi
authors.initials: CH
authors.lastname: Chang
authors.forename: Jau-Ching
authors.initials: JC
authors.lastname: Wu
authors.forename: Tsung-Hsi
authors.initials: TH
authors.lastname: Tu
authors.forename: Hung-Chieh
authors.initials: HC
authors.lastname: Chen
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Huang
authors.forename: Shu-Shya
authors.initials: SS
authors.lastname: Hseu
authors.forename: Jiing-Feng
authors.initials: JF
authors.lastname: Lirng
authors.forename: Shuu-Jiun
authors.initials: SJ
authors.lastname: Wang
authors.forename: Henrich
authors.initials: H
authors.lastname: Cheng
authors.forename: Chin-Chu
authors.initials: CC
authors.lastname: Ko
mesh_terms: D000328:Adult; D017217:Blood Patch, Epidural; D046648:Hematoma, Subdural, Intracranial / Q000150:complications*; D006801:Humans; D019585:Intracranial Hypotension / Q000150:complications* / Q000628:therapy; D008297:Male