A Case of Spontaneous Intracranial Hypotension associated with Bilateral Chronic Subdural Hematoma that was rapidly Aggravated during Conservative Therapy

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  • 保存的治療中に急激な症状増悪を呈した特発性頭蓋内圧低下症の1例

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Abstract

We report a case of spontaneous intracranial hypotension (SIH) with bilateral chronic subdural hematoma. The patient was a 32-year-old healthy woman who complained of having a postural headache for the last 1 month. Lumbar spinal tap revealed her cerebrospinal fluid pressure (CSF) to be 50 mmH_20. Gadolinium enhanced MRI showed diffuse meningeal enhancement and RI-cisternography revealed early accumulation of the tracer in her bladder. Conservative therapy was employed and on the eighteenth day she complained of a headache even though she was in the supine position. Three days later she rapidly became comatose and CT revealed enlargement of the left subdural hematoma. The hematoma was evacuated and a continuous epidural saline infusion was administered for 48 hours. She recovered her consciousness the next morning but partial right homonymous hemianopsia and slight left hemiparesis were seen as sequel to the central herniation. SIH is generally considered to have a benign prognosis, but when it is associated with subdural hematoma trantentorial herniation might occur, so the patient should be kept under careful observation.

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