title: Treatment and prognosis of subdural hematoma in patients with spontaneous intracranial hypotension.
abstract: OBJECTIVE
  The objective of this article is to elucidate the outcome, prognostic predictors and timing of surgical intervention for subdural hematoma (SDH) in patients with spontaneous intracranial hypotension (SIH).
  
  
  METHODS
  Patients with SDH were identified retrospectively from 227 consecutive SIH patients. Data were collected on demographics, clinical courses, neuroimaging findings, and treatment of SDH, which was later divided into conservative treatment, epidural blood patches (EBP), and surgical intervention. Poor outcome was defined as severe neurological sequelae or death.
  
  
  RESULTS
  Forty-five patients (20%) with SDH (mean maximal thickness 11.9 ± 6.2 mm) were recruited. All 15 patients with SDH <10 mm achieved good outcomes by either conservative treatment or EBP. Of 30 patients with SDH ≥10 mm, patients with uncal herniation (n = 3) had poor outcomes, even after emergent surgical evacuation (n = 2), compared to those without (n = 27) (100% vs. 0%, p < 0.001). Fourteen patients underwent surgical evacuation, resulting in good outcomes in all 12 who received early intervention and poor outcomes in the remaining two who received delayed intervention after Glasgow Coma Scale (GCS) score ≤8 (100% vs. 0%, p = 0.01).
  
  
  CONCLUSIONS
  Uncal herniation results in poor outcomes in patients with SIH complicated with SDH. In individuals with SDH ≥10 mm and decreased GCS scores, early surgical evacuation might prevent uncal herniation.
authors.affiliation: Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan.
authors.forename: Ying-Chu
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taiwan Brain Research Center, National Yang-Ming University School of Medicine, Taiwan Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan.
authors.forename: Yen-Feng
authors.initials: YF
authors.lastname: Wang
authors.affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan.
authors.forename: Jie-Yuan
authors.initials: JY
authors.lastname: Li
authors.affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan Brain Research Center, National Yang-Ming University School of Medicine, Taiwan Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan.
authors.forename: Shih-Pin
authors.initials: SP
authors.lastname: Chen
authors.affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan Department of Radiology, Taipei Veterans General Hospital, Taiwan.
authors.forename: Jiing-Feng
authors.initials: JF
authors.lastname: Lirng
authors.affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan Department of Anesthesiology, Taipei Veterans General Hospital, Taiwan.
authors.forename: Shu-Shya
authors.initials: SS
authors.lastname: Hseu
authors.affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan Division of Neurology, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan.
authors.forename: Hsin
authors.initials: H
authors.lastname: Tung
authors.affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan Division of Neurology, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan.
authors.forename: Po-Lin
authors.initials: PL
authors.lastname: Chen
authors.affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan Brain Research Center, National Yang-Ming University School of Medicine, Taiwan Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan.
authors.forename: Shuu-Jiun
authors.initials: SJ
authors.lastname: Wang
authors.affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan Brain Research Center, National Yang-Ming University School of Medicine, Taiwan Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan jlfuh@vghtpe.gov.tw.
authors.forename: Jong-Ling
authors.initials: JL
authors.lastname: Fuh
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D046648:Hematoma, Subdural, Intracranial / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D019585:Intracranial Hypotension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Spontaneous intracranial hypotension; epidural blood patch; increased intracranial pressure; subdural hematoma; uncal herniation