• Cheng-Hsi Chang, Jau-Ching Wu, Tsung-Hsi Tu, Hung-Chieh Chen, Wen-Cheng Huang, Shu-Shya Hseu, Jiing-Feng Lirng, Shuu-Jiun Wang, Henrich Cheng, and Chin-Chu Ko.
• Department of Anesthesiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC.
• J Chin Med Assoc. 2012 Nov 1;75(11):610-3.

AbstractA 36-year-old male had spontaneous intracranial hypotension (SIH) presenting with refractory headache for 4 months. Multiple epidural blood patches (EBPs) yielded relief of symptoms, but the course was complicated, with asymptomatic intracranial subdural hematoma (SDH). Except for SDH, other radiological diagnostic signs of SIH were resolved and the patient's headaches improved after EBP. Owing to a mass effect and persistent cerebrospinal fluid (CSF) leakage, surgical repair of the spinal leakage was performed, but no cranial procedures were carried out. Postoperatively, the SDH completely resolved, but there was still CSF leakage at the level where surgery was performed. The patient has remained free of headache or other events for 3 years. It was reduction rather than elimination of the spinal CSF leak that yielded remission of SIH. In summary, intracranial SDH can be a complication of inadequately treated SIH (i.e. persistent minor CSF leakage). Management of SDH should focus on correction of the underlying SIH rather than craniotomy for hematoma evacuation.Copyright © 2012. Published by Elsevier B.V.

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