Hematoma puncture and drainage combined with epidural blood patch in the treatment of subdural hematoma and venous cerebral infarction with spontaneous intracranial hypotension: one case report

Abstract

Objective To report a case of subdural hematoma (SDH) puncture and drainage combined with epidural blood patch (EBP) in the treatment of spontaneous intracranial hypotension (SIH) complicated with SDH and venous cerebral infarction, and summarize the diagnostic and treatment ideas. Methods and Results A male patient presented with sudden headache accompanied by hemiplegia, the headache was relieved in recumbent position and aggravated when standing or sitting for a long time. He was initially diagnosed as acute cerebral infarction before hospitalization and was given rt⁃PA intravenous thrombolysis. And then was diagnosed as cerebral venous thrombosis (CVT), which was treated through dehydration and anticoagulation, during which bilateral SDH occurred and progressive aggravated, and sent to Department of Emergency of Xuanwu Hospital, Capital Medical University. He was diagnosed as bilateral frontotemporal parietal SDH and effusion, CVT with venous cerebral infarction, and SIH. Soft channel twist drill craniotomy was performed firstly, then targeted autologous EBP were performed when the condition came to steady. The patients' symptoms improved, and residual SDH absorbed gradually. Conclusions For CVT patients accompanied by focal nerve dysfunction and SDH showed postural headache, the possibility of SIH could be considered, and stereotactic soft channel SDH puncture and drainage combined with targeted autologous EBP can play a curative effect.

Keywords

• intracranial hypotension
• hematoma
• subdural
• intracranial
• intracranial thrombosis
• cerebral veins
• drainage
• epidural blood patch (not in mesh)