Abstract
Subdural haematoma (SDH) is a potentially life-threatening complication in patients with spontaneous intracranial hypotension (SIH). In serious cases, SIH patients who present with SDHs develop neurological deficits, a decreased level of consciousness, or cerebral herniation, and may even require an urgent neurosurgical drainage. Despite numerous publications on SDHs, few report its potential risk factors in patients with SIH. In this study, we retrospectively investigated 93 consecutive SIH patients and divided them into an SDH group (n = 25) and a non-SDH (NSDH) group (n = 68). The clinical and radiographic characteristics of these 93 patients were analyzed, and then univariate analysis and further multiple logistic regression analysis were performed to identify the potential risk factors for the development of SDHs. The univariate analysis showed that advanced age, male gender, longer clinical course, dural enhancement, and the venous distension sign were associated with the development of SDHs. However, multivariate analysis only included the latter three factors. Our study reveals important radiological manifestations for predicting the development of SDHs in patients with SIH.
Highlights
Spontaneous intracranial hypotension (SIH) is increasingly recognized as a noteworthy cause of orthostatic headache, resulting from a spontaneous cerebrospinal fluid (CSF) leak often associated with an underlying generalized connective tissue disorder [1,2,3]
Our main finding was that the clinical course duration, dural enhancement, and venous distension sign (VDS) were correlated with the development of Subdural haematoma (SDH) in patients with SIH
According to de Noronha et al [6], published reports are unclear about the pathological nature of "collection", "effusion", “hygroma" and "haematoma", and these terms are used interchangeably
Summary
Spontaneous intracranial hypotension (SIH) is increasingly recognized as a noteworthy cause of orthostatic headache, resulting from a spontaneous cerebrospinal fluid (CSF) leak often associated with an underlying generalized connective tissue disorder [1,2,3]. SIH patients with SDHs develop neurological deficits, decreased levels of consciousness, or even cerebral. Risk Factors for SDH in Patients with SIH herniation [11]. Urgent neurosurgical drainage is required when the level of consciousness is decreased or the maximum thickness of the SDHs is >1 cm [12]. The rupture of bridging veins pulled away from the dura and brain descent due to low intracranial pressure have been widely proposed for the development of SDHs [1,2,3], the pathophysiology of SDHs in SIH remains unknown. Investigation of the risk factors for SDH may help to better understand its pathophysiology
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