Premium
Clinical Features of Patients With Spontaneous Intracranial Hypotension Complicated With Bilateral Subdural Fluid Collections
Author(s) -
Kim Jang Hun,
Roh Haewon,
Yoon WonKi,
Kwon TaekHyun,
Chong Kyuha,
Hwang SoonYoung,
Kim Jong Hyun
Publication year - 2019
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.13525
Subject(s) - medicine , receiver operating characteristic , confidence interval , odds ratio , spontaneous intracranial hypotension , subarachnoid hemorrhage , logistic regression , retrospective cohort study , surgery , cerebrospinal fluid
Background Subdural hygromas are often found bilaterally in spontaneous intracranial hypotension (SIH). They frequently progress to chronic subdural hematomas (CSDHs), and if the hematomas are formed, it is difficult to consider SIH as an underlying cause. Whether SIH is underlying or not among the patients presenting bilateral subdural fluid collections (hygromas or CSDHs) is clinically important because the treatment strategy should be different between them. Objectives We designed a retrospective case‐control study to figure out differential clinical features of the patients presenting bilateral symptomatic subdural fluid collections owing to SIH. Methods Sixty‐two patients with bilateral symptomatic subdural fluid collections were enrolled, and their data on general demographics, clinical courses, radiological findings, treatments, and outcomes were collected. The patients were divided into “SIH” and “Non‐SIH” groups, and a simple logistic regression analysis was performed to clarify the differences between the groups. The consequent receiver operating characteristics (ROC) curve analyses were performed with the significant predictors. Results Eight patients (13%) were diagnosed with SIH. Young age (odds ratio [OR] = 0.831, 95% confidence interval [CI]: 0.743‐0.929, P = .0012), no underlying disease (OR = 0.062, 95% CI: 0.007‐0.544, P = .0121), radiological features of brain sagging (OR = 10.36, 95% CI: 0.912‐93.411, P = .0017), pseudo‐subarachnoid hemorrhage (OR = 15.6, 95% CI: 2.088‐116.52, P = .0074), and small amount of fluid collections (OR = 0.719, 95% CI: 0.579‐0.893, P = .0029) were significantly associated with SIH group. ROC curve analyses were performed in parameters of age and amount of fluid collection and the cut‐off values for each parameter were ≤55 years old and ≤22.08 mm, respectively. Patients diagnosed with SIH underwent epidural blood patches and showed good results, except 1 patient who underwent burr‐hole trephinations. Conclusion Bilateral subdural fluid collections due to underlying SIH is associated with young age (≤55 years old), no underlying diseases, smaller amount of fluid collections (≤22.08 mm of depth), and radiological findings of brain sagging or pseudo‐subarachnoid hemorrhages.