Spontaneous Intracranial Hypotension Manifesting as a Unilateral Subdural Hematoma with a Marked Midline Shift
Spontaneous intracranial hypotension (SIH) is a syndrome in which hypovolemia of the cerebrospinal fluid (CSF) results in various symptoms. Although its prognosis is usually benign, cases with a rapid neurologic deterioration resulting in an altered mental status have been reported. One of the chara...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Karger Publishers
2015-04-01
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| Series: | Case Reports in Neurology |
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| Online Access: | http://www.karger.com/Article/FullText/381667 |
| _version_ | 1818117818073219072 |
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| author | Joji Inamasu Shigeta Moriya Junpei Shibata Tadashi Kumai Yuichi Hirose |
| author_facet | Joji Inamasu Shigeta Moriya Junpei Shibata Tadashi Kumai Yuichi Hirose |
| author_sort | Joji Inamasu |
| collection | DOAJ |
| description | Spontaneous intracranial hypotension (SIH) is a syndrome in which hypovolemia of the cerebrospinal fluid (CSF) results in various symptoms. Although its prognosis is usually benign, cases with a rapid neurologic deterioration resulting in an altered mental status have been reported. One of the characteristic radiographic findings in such cases is the presence of bilateral accumulation of subdural fluid (hematoma/hygroma). When SIH-related subdural hematoma is present only unilaterally with a concomitant midline shift, making an accurate diagnosis may be challenging, and inadvertent hematoma evacuation may result in further neurologic deterioration. We report a 58-year-old woman with an altered mental status who had visited a local hospital and in whom a brain CT showed a unilateral subdural hematoma with a marked midline shift. She was referred to our department because of her neurologic deterioration after hematoma evacuation. A CT myelography revealed a massive CSF leakage in the entire thoracic epidural space. She made a full neurologic recovery following blood patch therapy. Our case is unique and educational because the suspicion for SIH as an underlying cause of subdural hematoma is warranted in nongeriatric patients not only with bilateral but also unilateral lesions. An immediate search for CSF leakage may be important in cases with failed hematoma evacuation surgery. |
| first_indexed | 2024-12-11T04:44:27Z |
| format | Article |
| id | doaj.art-51b6594beef94d2eb76eaa5026b584d6 |
| institution | Directory Open Access Journal |
| issn | 1662-680X |
| language | English |
| last_indexed | 2024-12-11T04:44:27Z |
| publishDate | 2015-04-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Neurology |
| spelling | doaj.art-51b6594beef94d2eb76eaa5026b584d62022-12-22T01:20:33ZengKarger PublishersCase Reports in Neurology1662-680X2015-04-0171717710.1159/000381667381667Spontaneous Intracranial Hypotension Manifesting as a Unilateral Subdural Hematoma with a Marked Midline ShiftJoji InamasuShigeta MoriyaJunpei ShibataTadashi KumaiYuichi HiroseSpontaneous intracranial hypotension (SIH) is a syndrome in which hypovolemia of the cerebrospinal fluid (CSF) results in various symptoms. Although its prognosis is usually benign, cases with a rapid neurologic deterioration resulting in an altered mental status have been reported. One of the characteristic radiographic findings in such cases is the presence of bilateral accumulation of subdural fluid (hematoma/hygroma). When SIH-related subdural hematoma is present only unilaterally with a concomitant midline shift, making an accurate diagnosis may be challenging, and inadvertent hematoma evacuation may result in further neurologic deterioration. We report a 58-year-old woman with an altered mental status who had visited a local hospital and in whom a brain CT showed a unilateral subdural hematoma with a marked midline shift. She was referred to our department because of her neurologic deterioration after hematoma evacuation. A CT myelography revealed a massive CSF leakage in the entire thoracic epidural space. She made a full neurologic recovery following blood patch therapy. Our case is unique and educational because the suspicion for SIH as an underlying cause of subdural hematoma is warranted in nongeriatric patients not only with bilateral but also unilateral lesions. An immediate search for CSF leakage may be important in cases with failed hematoma evacuation surgery.http://www.karger.com/Article/FullText/381667Blood patchMidline shiftSpontaneous intracranial hypotensionSubdural hematoma, unilateral |
| spellingShingle | Joji Inamasu Shigeta Moriya Junpei Shibata Tadashi Kumai Yuichi Hirose Spontaneous Intracranial Hypotension Manifesting as a Unilateral Subdural Hematoma with a Marked Midline Shift Case Reports in Neurology Blood patch Midline shift Spontaneous intracranial hypotension Subdural hematoma, unilateral |
| title | Spontaneous Intracranial Hypotension Manifesting as a Unilateral Subdural Hematoma with a Marked Midline Shift |
| title_full | Spontaneous Intracranial Hypotension Manifesting as a Unilateral Subdural Hematoma with a Marked Midline Shift |
| title_fullStr | Spontaneous Intracranial Hypotension Manifesting as a Unilateral Subdural Hematoma with a Marked Midline Shift |
| title_full_unstemmed | Spontaneous Intracranial Hypotension Manifesting as a Unilateral Subdural Hematoma with a Marked Midline Shift |
| title_short | Spontaneous Intracranial Hypotension Manifesting as a Unilateral Subdural Hematoma with a Marked Midline Shift |
| title_sort | spontaneous intracranial hypotension manifesting as a unilateral subdural hematoma with a marked midline shift |
| topic | Blood patch Midline shift Spontaneous intracranial hypotension Subdural hematoma, unilateral |
| url | http://www.karger.com/Article/FullText/381667 |
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