Abstract
A 44-year-old male was admitted due to the sudden onset of postural headache with no significant abnormalities on physical and neurological examination. The image study showed bilateral subdural hemorrhage, characteristic findings of spontaneous intracranial hypotension and cerebral spinal fluid leakage on the cervical spine. During hospitalization, the patient's subdural hematoma recurred in spite of initial burr hole drainage and multiple epidural blood patches, and a second surgical drainage was indicated due to conscious deterioration. Postural headache is characteristic in spontaneous intracranial hypotension caused by cerebral spinal fluid leakage. Although this disease is often considered not life threatening, critical care and early surgical intervention are required in complicated cases. There is still controversy on the management of cerebrospinal fluid leakage: some experts insist on accurate localization and directed epidural blood patches, or even surgical repair; others advocate that multiple lumbar epidural blood patches are sufficient to heal patients.
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