Spontaneous intracranial hypotension complicated with cerebral venous thrombosis and subdural effusion: a case report

Murali Krishna Menon1, Thara Prathap2, Muhammed Jasim Abdul Jalal3 1Department of Neurology, Lakeshore Hospital and Research Centre, Ernakulam 682040, Kerala, India. 2Department of Radiology, Lakeshore Hospital and Research Centre, Ernakulam 682040, Kerala, India. 3Department of Family Medicine, Lakeshore Hospital and Research Centre, Ernakulam 682040, Kerala, India. Spontaneous intracranial hypotension treatment can be complicated by concomitant cerebral venous thrombosis and subdural hematoma. A 48 years old male, presenting orthostatic headache and neck pain for 1 month displayed sagittal sinus thrombosis and bilateral subdural effusions, as well as extradural fluid collection at T3-T8 level, upon magnetic resonance imaging. Cerebrospinal fluid opening pressure was 50 mmH2O, and a leak was confirmed at C2-C3 level by computed tomography (CT) myelogram. The presence of subdural hematoma precluded anticoagulation treatments. An autologous epidural blood patch at C2-C3 level under CT guidance improved the patient’s condition, remaining free of residual symptoms or recurrence at six-month follow-up.