[A case of bilateral chronic subdural hematoma due to spontaneous intracranial hypotension without orthostatic headache].
We herein present a case of bilateral chronic subdural hematoma(bilateral CSDH)caused by spontaneous intracranial hypotension(SIH)without orthostatic headache. A 67-year-old male patient with mild head injury suffered from a chronic, non-postural headache. Computed tomography of the brain showed bilateral CSDH. The hematomas were surgically evacuated using a closed drainage method. His headache immediately disappeared, but it recurred after 2 weeks. We further performed hematoma irrigation;however, his neurological status deteriorated with the development of pneumocephalus. Magnetic resonance imaging with gadolinium-DTPA showed diffuse pachymeningeal enhancement. His cerebrospinal fluid pressure was 3cmH2O, and radioisotope cisternography revealed cerebrospinal fluid leakage at the level of the cervicothoracic transition. No recurrence was found after 6 weeks of horizontal bed rest. The possibility of SIH should be considered in patients with CSDH, especially bilateral CSDH, even in elderly patients with a history of mild head trauma, and absence of orthostatic headache. Closed drainage method may be preferable in cases where surgical treatment is used.
Department of Neurosurgery, Tsukuba University Hospital.
Kazuki
K
Sakakura
Satoshi
S
Ayuzawa
Yosuke
Y
Masuda
Hidehiro
H
Kin
Akira
A
Matsumura
D000368:Aged; D006261:Headache; D020200:Hematoma, Subdural, Chronic / Q000209:etiology / Q000601:surgery*; D006801:Humans; D019585:Intracranial Hypotension / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D016896:Treatment Outcome