A case of bilateral chronic subdural hematoma due to spontaneous intracranial hypotension without orthostatic headache

• Published in: Nō shinkei geka Vol. 42; no. 4; p. 341
• Main Authors: Sakakura, Kazuki, Ayuzawa, Satoshi, Masuda, Yosuke, Kin, Hidehiro, Matsumura, Akira
• Format: Journal Article
• Language: Japanese
• Published: Japan 01-04-2014
• Subjects: Aged; Headache; Hematoma, Subdural, Chronic - etiology; Hematoma, Subdural, Chronic - surgery; Humans; Intracranial Hypotension - complications; Intracranial Hypotension - diagnosis; Intracranial Hypotension - surgery; Magnetic Resonance Imaging - methods; Male; Treatment Outcome
• ISSN: 0301-2603

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 3cmH
O, 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.