Epidural Blood Patch in Subdural Hematoma Due to SpontaneousIntracranial Hypotention: A Case Report

BACKGROUND: spontaneous intracranial hypotension (SIH) is an orthostatic headache syndrome withprotean symptoms and complications which is often misdiagnosed at initial presentation. SIH resultsfrom spontaneous CSF leakage leading to brain sag. The typical findings on cranial MR imaging consistof subdural fluid collections, enhancement of the pachymeninges, engorgement of venous structures,pituitary hyperemia, and sagging of the brain. Subdural hematoma may occur as a result of tearing ofbridging veins and usually develop into chronic subdural hematoma. The majority of patients withSDH due to SIH have chronic DSH and, therefore, rarely present with neurological deficits. Evacuationof SDH may be performed for large SDH with ME (mass effects), or when dilated or asymmetric pupilis present. However in most cases, evacuation of the hematoma is not necessary and may result inworsened outcomes. The epidural blood patch (EBP) is the mainstay of treatment. Fortunately, mostof these subdural hematomas can be managed with treatment directed at the underlying spinal CSFleak without the need for craniotomy.CASE REPORT: We report the case of ۴۲-year-old man with the chief complaint of orthostaticheadache. He was admitted to neurology ward and after imaging studies, it was found that he hasbilateral subdural hematoma.Due to the lack of history of trauma, underlying disease, andcoagulation disorder, and considering the imaging findings, the patient was referred to the paindepartment to perform an epidural blood patch. After performing the epidural blood patch, thepatient's pain was relieved immediately, and during a three-month follow-up period, the epiduralhematoma was completely absorbed.CONCLUSIONS: Spontaneous intracranial hypotension (SIH) is a highly misdiagnosed andunderdiagnosed disorder and requires a high index of suspicion for diagnosis. During the lastdecades, a much larger number of spontaneous cases are identified. Literature is a bit confusing, withsome authors recommending evacuation of subdural fluid in cases of