Abstract
The aim of the present study was to demonstrate the incidence of spinal cerebrospinal fluid (CSF) leaks in patients with nontraumatic intracranial subdural hematoma (SDH) and determine clinical parameters favoring such leaks. This retrospective study was approved by the institutional review board. Patients diagnosed with nontraumatic intracranial SDH who underwent computed tomography (CT) myelography between January 2012 and March 2018 were selected. 60 patients (male: female, 39:21; age range, 20–82 years) were enrolled and divided into CSF leak-positive and CSF leak-negative groups according to CT myelography data. Clinical findings were statistically compared between the two groups. Spinal CSF leak was observed in 80% (48/60) of patients, and it was significantly associated with an age of <69 years (p = 0.006). However, patients aged ≥69 years also had a tendency to exhibit spontaneous intracranial hypotension (SIH)-induced nontraumatic intracranial SDH (60.87%; 14/23). Therefore, CT myelography is recommended to be performed for the evaluation of possible SIH in patients with nontraumatic intracranial SDH, particularly those aged <69 years. Patients aged ≥69 years are also good candidates for CT myelography because SIH tends to occur even in this age group.
Highlights
Nontraumatic intracranial subdural hematoma (SDH) can be induced by a variety of causes
Spontaneous intracranial hypotension (SIH) is a disorder characterized by decreased cerebrospinal fluid (CSF) volume and pressure, and it is caused by a persistent CSF leak through a dural defect along the neuraxis [5]
Neurosurgeons at our institution requested computed tomography (CT) myelography to rule out SIH in patients with nontraumatic SDH without any explainable cause
Summary
Nontraumatic intracranial subdural hematoma (SDH) can be induced by a variety of causes. Causative factors for chronic SDH include stretching of bridging veins due to extensive brain atrophy, fragile neovasculatures associated with neomembrane formation after subdural hygroma or acute SDH [4]. For both acute and chronic SDH, conservative management (reversal of anticoagulation and prophylactic anticonvulsants) or surgical treatment (hematoma evacuation) is used depending on the patient’s symptoms and extent of hematoma [4]. A CSF leak can result in downward traction on the brain, causing headaches, subdural fluid collection, and possible brain herniation [5]
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