Spontaneous intracranial hypotension with bilateral subdural hemorrhage: Is conservative management adequate?

• Main Authors: Mohammed Tauqeer Ahmad, Shahul Hameed, Kei Pin Lin, Kumar M Prakash
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2013-01-01
• Series: Annals of Indian Academy of Neurology
• Subjects: Intracranial hypotension; pachymeningeal enhancement; subdural hemorrhage
• Online Access: http://www.annalsofian.org/article.asp?issn=0972-2327;year=2013;volume=16;issue=1;spage=94;epage=96;aulast=Ahmad

The aim of this study is to report a case of spontaneous intracranial hypotension complicated by bilateral subdural hemorrhage that resolved with conservative management. A young male presented with severe orthostatic headache associated with dizziness, neck pain and diplopia. Brain imaging revealed characteristic pachymeningeal enhancement and bilateral subdural hemorrhage. Radionuclide cisternography confirmed the Cerebrospinal fluid leak at the cervical 5 and cervical 6 vertebral level. He had clinical and radiological resolution with bed rest, hydration and analgesics and has remained symptom free since then. Spontaneous intracranial hypotension may be complicated by bilateral subdural hemorrhage. A conservative treatment approach is a viable option, as it may help improve the clinical and radiological outcome, especially when interventional facilities are not available.