title: Epidural blood patch for spontaneous intracranial hypotension with chronic subdural haematoma: A case report and literature review.
abstract: Spinal leakage of cerebrospinal fluid (CSF) is considered to be the primary cause of spontaneous intracranial hypotension (SIH). Subdural haematoma (SDH) is a serious complication of SIH. This current report presents a case of bilateral SDH with SIH that was treated with epidural blood patching (EBP). A 43-year-old male complained of experiencing orthostatic headaches for 2 months without neurological signs. The patient worsened in a local hospital and was transferred to the Sir Run Run Hospital. Brain computed tomography showed bilateral SDH with a midline shift. The patient underwent emergency trephination in the left frontal temporal region. Postoperative magnetic resonance myelography showed a CSF leak originating at the T11-L2 level. As a consequence of clinical deterioration of the patient, EBP was subsequently performed at the T12-L1 level. The headache was rapidly relieved and later the SDH was completely absorbed. This case report and literature review aims to remind clinicians that SIH can cause SDH and that EBP is a viable treatment option.
authors.affiliation: Department of Critical Care Medicine, Sir Run Run Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Critical Care Medicine, Sir Run Run Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Jin
authors.affiliation: Department of Critical Care Medicine, Sir Run Run Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China zjpkhan@163.com.
authors.forename: Kong-Han
authors.initials: KH
authors.lastname: Pan
mesh_terms: D000328:Adult; D017217:Blood Patch, Epidural; D006261:Headache / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D020200:Hematoma, Subdural, Chronic / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D019585:Intracranial Hypotension / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D014057:Tomography, X-Ray Computed; D014207:Trephining
keywords: Spontaneous intracranial hypotension; epidural blood patching; subdural haematoma