Perez-Vega Carlos, Robles-Lomelin Pilar, Robles-Lomelin Isabel, Diaz-Alba Alexandra, Navarro Victor Garcia
School of Medicine and Health Sciences, Tecnologico de Monterrey, Zapopan, Jalisco, Mexico.
Department of Neurology, Instituto Neurologico de Guadalajara S.C., Guadalajara, Jalisco, Mexico.
Surg Neurol Int. 2020 Oct 2;11:316. doi: 10.25259/SNI_385_2020. eCollection 2020.
Spontaneous intracranial hypotension (SIH) is an uncommon, benign, and generally self-limiting condition caused by low cerebrospinal fluid (CSF) volume and pressure usually caused by a CSF leak. Patients with SIH have an increased incidence of subdural hematomas (SDH), which may be bilateral and recurrent.
We report a unique case of a man presenting with SIH and bilateral SDH that were drained with bilateral craniotomies. During drain removal, the patient had an acute neurological deterioration and a CT scan showed SDH recurrence. The patient had two new recurrent SDH afterwards. After the third surgical intervention, the drain was removed in the OR with concomitant subdural saline infusion, there was no recurrence of SDH after that and the patient has had no further complications after a 2-year follow-up.
Patients with intracranial hypotension are predisposed to form SDH. In this case, drain removal caused further decrease in intracranial pressure and triggered a new SDH formation, subdural saline irrigation masked atmospheric pressure and prevented this complication from happening again.
自发性颅内低压（SIH）是一种罕见的、良性的且通常自限性的疾病，由脑脊液（CSF）量和压力降低引起，通常是由于脑脊液漏所致。SIH患者硬膜下血肿（SDH）的发生率增加，可能为双侧性且会复发。
我们报告了一例独特的病例，一名男性患者出现SIH和双侧SDH，通过双侧开颅手术进行引流。在拔除引流管时，患者出现急性神经功能恶化，CT扫描显示SDH复发。此后患者又出现两次新的SDH复发。在第三次手术干预后，在手术室拔除引流管的同时进行硬膜下盐水输注，此后SDH未再复发，经过2年随访，患者未出现进一步并发症。
颅内低压患者易形成SDH。在本病例中，拔除引流管导致颅内压进一步降低并引发新的SDH形成，硬膜下盐水灌注掩盖了大气压并防止该并发症再次发生。
