Article ; Online: Spontaneous intracranial hypotension presenting with bilateral subdural hematoma: Decision-making and treatment strategies.
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
2024 Volume 121, Page(s) 77–82
Abstract: Background: The timing and decision to drain subdural hematoma (SDH) in spontaneous intracranial hypotension (SIH) remains a dilemma. We reviewed our experience of bilateral SDH secondary to SIH, focusing on decision making and treatment strategies.: ... ...
Abstract | Background: The timing and decision to drain subdural hematoma (SDH) in spontaneous intracranial hypotension (SIH) remains a dilemma. We reviewed our experience of bilateral SDH secondary to SIH, focusing on decision making and treatment strategies. Methods: We retrospectively reviewed bilateral SDH secondary to SIH between March 2010 and September 2021. Baseline characteristics of patients, diagnosis, radiologic findings, treatments, and clinical outcome were investigated. Results: Fifteen patients (7 men, 8 women) with bilateral SDH secondary to SIH were included in this study. Initially, patients were treated conservatively (4 patients, 26.7 %), with an epidural blood patch (EBP, 3 patients, 20.0 %), and SDH drainage followed by the Trendelenburg position (8 patients, 53.3 %). All 3 patients that were initially treated with EBP required SDH drainage. Of the 8 patients initially treated with SDH drainage via burr hole followed by Trendelenburg position, 7 patients showed sustained improvements without EBP; however, 1 patient needed EBP. Deterioration to coma occurred in 6 out of 15 patients (40.0 %). All 6 deteriorated patients immediately recovered after SDH drainage with Trendelenburg position; 5 achieved sustained improvement without EBP and 1 required EBP. During the follow-up period, 14 out of 15 patients (93.3 %) showed good recovery. Conclusions: Evacuation of SDH is not always necessary in SIH; however, we did not hesitate to perform hematoma drainage, in deteriorated patients or those with thick hematoma that is associated with significant sagging and cistern effacement. This can prevent irreversible neurologic complications. Moreover, the Trendelenburg position may help to achieve sustained improvement without additional treatment. |
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MeSH term(s) | Male ; Humans ; Female ; Intracranial Hypotension/complications ; Intracranial Hypotension/diagnostic imaging ; Retrospective Studies ; Hematoma, Subdural/complications ; Hematoma, Subdural/diagnostic imaging ; Drainage/adverse effects ; Blood Patch, Epidural |
Language | English |
Publishing date | 2024-02-16 |
Publishing country | Scotland |
Document type | Review ; Journal Article |
ZDB-ID | 1193674-5 |
ISSN | 1532-2653 ; 0967-5868 |
ISSN (online) | 1532-2653 |
ISSN | 0967-5868 |
DOI | 10.1016/j.jocn.2024.02.005 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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