Bhenderu Lokeshwar S, Wong Marcus, Britz Gavin
J Neurosurg Case Lessons. 2023 Feb 6;5(6). doi: 10.3171/CASE22445.
Spontaneous intracranial hypotension (SIH) is a relatively rare and underdiagnosed disease. SIH can lead to subdural hematomas (SDHs) and other complications. SDHs secondary to SIH are difficult to manage, with no consensus in management, and SDHs commonly recur if underlying SIH is not treated.
A 46-year-old male with vague sensory and orientation symptoms presented with bilateral SDHs, which were treated with middle meningeal artery (MMA) embolization and burr hole evacuation. The patient improved initially but had recurrent encephalopathy and SDHs. The patient received 3 epidural blood patches (EBPs) over 8 days with continued improvement. A 78-year-old female presented with headaches, and imaging revealed a left chronic SDH. She underwent MMA embolization and mini-craniotomy for SDH evacuation. Her symptoms returned and imaging revealed a recurrent SDH. Pan spine computed tomography myelography showed a high thoracic cerebrospinal fluid (CSF) leak. She underwent 3 EBPs over 8 days with neurological improvement and stabilization of her SDH.
The authors show that, if SDH recurs after initial treatment with MMA embolization, then SIH should be strongly considered and treated with EBPs. Further investigation is required to determine the role of targeted or blind EBPs and the use of imaging to find the source of occult CSF leaks causing SIH.
自发性颅内低压（SIH）是一种相对罕见且诊断不足的疾病。SIH可导致硬膜下血肿（SDH）及其他并发症。SIH继发的SDH难以处理，在治疗上尚无共识，且如果潜在的SIH未得到治疗，SDH通常会复发。
一名46岁男性出现双侧SDH，伴有模糊的感觉和定向症状，接受了脑膜中动脉（MMA）栓塞和钻孔引流治疗。患者最初有所改善，但出现了复发性脑病和SDH。患者在8天内接受了3次硬膜外血贴（EBP）治疗，病情持续改善。一名78岁女性出现头痛，影像学检查发现左侧慢性SDH。她接受了MMA栓塞和微创开颅手术以清除SDH。她的症状复发，影像学检查显示SDH复发。全脊柱计算机断层扫描脊髓造影显示胸段高位脑脊液（CSF）漏。她在8天内接受了3次EBP治疗，神经功能改善，SDH稳定。
作者表明，如果在最初采用MMA栓塞治疗后SDH复发，则应高度怀疑SIH并采用EBP进行治疗。需要进一步研究以确定靶向或盲目EBP的作用以及利用影像学检查寻找导致SIH的隐匿性CSF漏的来源。
