Abstract

The nature and clinical relevance of subdural hemorrhage(SDH) in patient with spontaneous intracranial hypotension (SIH) remain unclear. We report two cases of SIH with SDH, and suggest optimal procedure for diagnosis and treatment. Forty three and 31-year-old men presented with severe orthostatic headache, and cranial magnetic resonance imaging showed bilateral subdural hematomas and diffuse meningeal enhancement. There were no history of head trauma and lumbar puncture. Indium-111 Radioisotope cisternography through lumbar puncture showed multiple CSF leaks along the spinal axis. Orthostatic headache disappeared after treatment with epidural blood patch. However, those patients showed drowsy mentality in a few days. Brain CT revealed increased amount of SDH. Surgical removal of subdural hematoma was performed. Both patients were recovered and did not complain orthostatic headache any more. We suggest that additional epidural blood patch at the site of lumbar puncture could be helpful to prevent potential CSF leakage.