Senapati Satya Bhusan, Acharya Abhijit, Mohanty Ranjan Kumar, Puppala Sumirini
Department of Neurosurgery, Institute of Medical Sciences and Sum Hospital, Bhubaneswar, Odisha, India.
Department of Neurology, Institute of Medical Sciences and Sum Hospital, Bhubaneswar, Odisha, India.
Asian J Neurosurg. 2025 Mar 18;20(2):427-430. doi: 10.1055/s-0045-1806730. eCollection 2025 Jun.
Cerebrospinal fluid (CSF) provides buoyant support to the brain and spinal cord. According to the Monroe-Kellie doctrine, confined space in the cranium causes any change in CSF volume contributing to significant intracranial pressure changes, which cause a variety of pathologies and symptoms. We, hereby, present a case of a 33-year-old gentleman who after a motorcycle road traffic accident came to us complaining of persistent headache and neck pain with subdural hematoma (SDH) like presentation, clinically and radiologically, but was reevaluated and diagnosed as traumatic intracranial hypotension and successfully managed surgically after that. Hygromas are believed to be compensatory enlargement of the subdural space due to the loss of CSF volume. The true mechanism of the development of SDH or hygroma due to intracranial hypotension is yet to be hypothesized but provisionally described by a rupture of the bridging veins by being pulled away from the dura because of the low intracranial pressure (ICP) and brain descent. Many prior cases in the literature are shown to have treated the patient with immediate burr hole and decompression of SDH, but this paradoxically worsens the patient due to further lowering of ICP. The causes of prolonged postconcussion headaches are often unidentified, of which intracranial hypotension caused by a CSF leak is potentially under-recognized. In such cases, bilateral SDH with mass effect must be ruled out of any CSF leak before attempting the lifesaving decompressive surgery, as it may paradoxically lead to further morbidity and mortality of the patient.
脑脊液（CSF）为脑和脊髓提供浮力支持。根据Monroe-Kellie学说，颅骨内的密闭空间使得脑脊液体积的任何变化都会导致显著的颅内压变化，进而引发各种病理状况和症状。在此，我们报告一例33岁男性患者，他在摩托车道路交通事故后前来就诊，主诉持续头痛和颈部疼痛，临床及影像学表现类似硬膜下血肿（SDH），但经重新评估后诊断为创伤性颅内低压，随后通过手术成功治愈。蛛网膜下腔积液被认为是由于脑脊液体积减少导致硬膜下腔的代偿性扩大。颅内低压导致SDH或蛛网膜下腔积液形成的确切机制尚待推测，但初步认为是由于颅内压（ICP）降低和脑下移，桥静脉被牵拉离开硬脑膜而破裂所致。文献中许多先前的病例显示，对患者立即进行钻孔引流和SDH减压治疗，但这反而会因进一步降低ICP而使患者病情恶化。脑震荡后长期头痛的原因往往不明，其中脑脊液漏导致的颅内低压可能未得到充分认识。在这种情况下，在尝试进行挽救生命的减压手术之前，必须排除任何脑脊液漏导致的伴有占位效应的双侧SDH，因为这可能会反常地导致患者进一步发病和死亡。
