• Low Jacob Chen Ming JCM Department of Neurosurgery, St George's Hospital, London, United Kingdom. Electronic address: Jacob.CM.Low@doctors.org.uk., Anan Shtaya, and Samantha Hettige.
• Department of Neurosurgery, St George's Hospital, London, United Kingdom. Electronic address: Jacob.CM.Low@doctors.org.uk.
• World Neurosurg. 2017 Sep 1; 105: 1036.e11-1036.e13.

BackgroundIntracranial hypotension (IH) is a recognized cause of coma; however, the diagnosis is often challenging, especially in patients with superimposed traumatic brain injury.Case DescriptionA 67-year-old woman became comatose following evacuation of bilateral acute subdural hematomas with concurrent respiratory failure. Imaging and intraparenchymal intracranial pressure monitoring confirmed secondary IH. She was managed with an epidural blood patch and a 72-hour period in the Trendelenburg position guided by intracranial pressure monitoring and clinical assessment. She subsequently made an excellent neurologic recovery from an initial Glasgow Coma Scale score of 3 to a score of 15.ConclusionsSecondary IH can easily be missed in patients who have sustained a primary brain injury. In patients with a poor neurologic recovery, clinicians should rule out secondary IH as a potential cause, as immediate treatment can lead to profound clinical improvement.Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

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