Abstract
Spontaneous intracranial hypotension (SIH) is uncommon and postulated to occur due to spontaneous cerebrospinal fluid (CSF) leak. Subdural hemorrhage is a rare but serious complication of intracranial hypotension. With a paucity of high-level evidence to guide treatment, its management remains challenging.
Highlights
Spontaneous intracranial hypotension (SIH) is an uncommon condition
Case presentation: We report a case of spontaneous intracranial hypotension which was successfully treated with an epidural blood patch
We highlight an interesting case of SIH presenting atypically with cranial nerve IV palsy and its successful management with epidural blood patch
Summary
Spontaneous intracranial hypotension (SIH) is an uncommon condition. The non-specificity and variety of the presenting symptoms often lead to delayed diagnosis and treatment of SIH. We describe a case of SIH presenting atypically with cranial nerve IV palsy and subsequent resolution of symptoms after burr hole drainage of bilateral subdural haematomas (SDH) and the administration of epidural blood patch. Magnetic resonance imaging (MRI) of the brain showed bilateral holo hemispheric subdural haematomas (right 0.7 cm, left 1 cm) and sagging of the hypothalamus which raised the suspicion of intracranial hypotension. The patient was offered bilateral burr hole drainage of SDH under general anaesthesia and an awake epidural blood patch. Burr hole craniotomy released dark red SDH under moderate pressure; the brain expanded quickly after drainage He was extubated uneventfully and a detailed neurological examination was performed which did not show any new deficits. The left trochlear nerve palsy gradually improved and was found to have resolved completely at follow-up 5 months post-EBP
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
