Ｓｐｏｎｔａｎｅｏｕｓ　ｉｎｔｒａｃｒａｎｉａｌ　ｈｙｐｏｔｅｎｓｉｏｎに合併した両側慢性硬膜下血腫の一例

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  • A Case of Bilateral Chronic Subdural Hematoma Associated with Spontaneous Intracranial Hypotension.

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We report a case of bilateral chronic subdural hematoma associated with spontaneous intracranial hypotension. While wiping a wall, a 44-year-old woman felt sudden back pain followed by the gradual development of a recurrent severe occipital headache. She had no history of head injury, craniotomy, or lumbar puncture. CT scans on admission showed tight basal cisterns and vague visualization of the bilateral Sylvian fissures. A lumbar puncture demonstrated slightly xanthochromic cerebrospinal fluid (CSF); initial CSF pressure was 20 mm H2O in the lateral recumbent position. Cerebral angiography (digital subtraction angiography) was performed twice, but there was no sign of cerebral vascular disorder. An MRI clearly showed bilateral enlargement of subdural spaces. After 3 weeks of bed rest, her headache improved and became unrelated to body position. One month later, she underwent bilateral burr hole surgery for the chronic subdural hematoma. During surgery, the old hematoma spurted out. Her headache disappeared completely, and there has been no recurrence. Primary intracranial hypotension sometimes mimics subarachnoid hemorrhage with regard to xanthochromic CSF. We stress careful interviewing about the onset of headache for diagnosis. We believe that delaying surgery in this type of bilateral subdural hematoma, except in severe cases, may be better to avoid recurrence.

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