title: Intracranial hemorrhage following surgery for occult spinal dysraphism: a case-based update.
abstract: BACKGROUND
  Intracranial cerebrospinal fluid (CSF) volume depletion causes diverse clinical syndromes most of them constituting the manifestations of decreased intracranial pressure. Subdural collections or chronic subdural hematomas are the best-known consequences of persistent CSF leaks, especially in overshunted hydrocephalus. Continuous CSF escape also occurs after lumbar puncture, spinal anesthesia, and diverse spinal surgeries.
  
  
  METHODS
  A 6-year-old boy submitted to reoperation of spinal cord compression due to partial sacral agenesis complained of postoperative orthostatic headaches and vomiting initially attributed to CSF hypotension. There were neither subcutaneous fluid accumulations nor CSF leakage from the wound. The child was treated with strict bed rest and intravenous hydration for 5 days. On reassuming orthostatism, the patient had syncope but did not hit his head. A cranial computerized tomography scan showed an acute subdural hematoma that was managed conservatively with total recovery.
  
  
  CONCLUSIONS
  A review of current literature showed scanty reports of acute intracranial bleeding occurring after CSF depletion following spinal surgical procedures. To our knowledge, our reported patient represents the second case of this occurrence following surgery for closed spinal dysraphism in a child. The authors briefly review documented instances of acute subdural hematoma following spinal procedures, advise about its diagnosis, and suggest preventive measures.
authors: Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, El Palmar, Murcia, 30120, Spain, juanf.martinezlage@gmail.com.
authors: Juan F
authors: JF
authors: Martínez-Lage
authors: Antonio L
authors: AL
authors: López-Guerrero
authors: Claudio
authors: C
authors: Piqueras
authors: María-José
authors: MJ
authors: Almagro
authors: Amparo
authors: A
authors: Gilabert
mesh_terms: D002648:Child; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D009436:Neural Tube Defects / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D013116:Spinal Cord / Q000601:surgery; D014057:Tomography, X-Ray Computed