Spontaneous intracranial hypotension resulting in coma: Case report and review of the literature

Abstract

Spontaneous intracranial hypotension (SIH) has a wide range of clinical presentations. Cases of SIH that result in severe neurologic compromise have only very rarely been described.We describe our experience with a 70-year-old male who presented with a history of postural headache and imaging that demonstrated bilateral subdural hematomas. The patient's condition subsequently deteriorated and he became comatose despite an epidural blood patch and craniotomy to drain the subdural hematoma. We utilized a strategy of intraventricular saline infusion to normalize intracranial pressure. The patient ultimately required direct surgical ligation of a spinal perineural cyst before making a full recovery.Given the rarity of SIH presenting with severe neurologic deterioration and the unique treatment strategies required to manage this condition we conducted a review of the literature and discussed the management of the most severe complications of SIH. Keywords: Spontaneous intracranial hypotension, Neurosurgery, Subdural hematoma