title: Evaluation on a clinical course of subdural hematoma in patients undergoing epidural blood patch for spontaneous cerebrospinal fluid leak.
abstract: OBJECTIVE
  Subdural hematoma (SDH) is a frequent complication of spontaneous intracranial hypotension (SIH), in which epidural blood patch (EBP) may be applied as a treatment to stop cerebrospinal fluid (CSF) leak. However, a clinical course of SDH in SIH patients has not been sufficiently evaluated. We retrospectively evaluated the temporal relationships between EBP and SDH in the patients with SIH.
  
  
  METHODS
  Twenty-nine consecutive patients, diagnosed as SIH, were studied. Clinical records and images were retrospectively evaluated. When orthostatic headache continued for 2 weeks regardless of conservative treatment, EBP was performed under fluoroscopy.
  
  
  RESULTS
  We detected 13(45%) cases of SDH (mean age 44 years, 8 males and 5 females). In 6 patients, SDHs disappeared after effective EBP, i.e., after the disappearance of orthostatic headache. In 3 patients, SDHs were enlarged or recurred after effective EBP, and in 4 patients, SDHs were first detected after effective EBP.
  
  
  CONCLUSIONS
  The knowledge of the presence of these types of SDH (enlarged or recurred or detected after EBP) may deserve clinical attention.
authors: Department of Anesthesiology and Pain Medicine, Nara Medical University, Kashihara, Nara, Japan. kzume@naramed-u.ac.jp
authors: Keiji
authors: K
authors: Hashizume
authors: Keisuke
authors: K
authors: Watanabe
authors: Masahiko
authors: M
authors: Kawaguchi
authors: Aki
authors: A
authors: Fujiwara
authors: Hitoshi
authors: H
authors: Furuya
mesh_terms: D000328:Adult; D000368:Aged; D017217:Blood Patch, Epidural / Q000379:methods*; D065634:Cerebrospinal Fluid Leak; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D005260:Female; D006408:Hematoma, Subdural / Q000601:surgery*; D006801:Humans; D019585:Intracranial Hypotension / Q000150:complications / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
keywords: Epidural blood patch; Spontaneous intracranial hypotension; Subdural hematoma