Open AccessBrain herniation induced by drainage of subdural hematoma in spontaneous intracranial hypotension
Author(s) -
Silky Chotai,
Jong-Hyun Kim,
Joo Han Kim,
Taek Hyun Kwon
Publication year - 2013
Publication title -
asian journal of neurosurgery
Language(s) - English
Resource type - Journals
ISSN - 2248-9614
DOI - 10.4103/1793-5482.116390
Subject(s) - medicine , epidural blood patch , intracranial hypotension , hematoma , surgery , craniotomy , anesthesia , trendelenburg position , brain herniation , subarachnoid hemorrhage , midline shift , subdural hemorrhage , lumbar puncture , epidural hematoma , pneumocephalus , magnetic resonance imaging , cerebrospinal fluid , radiology , complication , pathology
Spontaneous intracranial hypotension (SIH), typically presents with orthostatic headache, low pressure on lumbar tapping, and diffuse pachymeningeal enhancement on magnetic resonance imaging. SIH is often accompanied by subdural fluid collections, which in most cases responds to conservative treatment or spinal epidural blood patch. Several authors advocate that large subdural hematoma with acute deterioration merits surgical drainage; however, few have reported complications following craniotomy. We describe a complicated case of SIH, which was initially diagnosed as acute subarachnoid hemorrhage with bilateral chronic subdural hematoma (SDH), due to unusual presentation. Burr hole drainage of subdural hematoma was performed due to progressive decrease of consciousness, which then resulted in a huge postoperative epidural hematoma collection. Prompt hematoma evacuation did not restore the patient's consciousness but aggravated downward brain herniation. Trendelenburg position and spinal epidural blood patch achieved a rapid improvement in patient's consciousness. This case indicates that the surgical drainage for chronic SDH in SIH can lead to serious complications and it should be cautiously considered.