2009 H1N1-associated acute encephalitis and encephalopathy appear to be variable in severity, including a subset of patients with a malignant clinical course complicated by high morbidity and mortality. Since the H1N1 influenza virus has not been detected in the CSF or brain tissue in patients with this diagnosis, the emerging view is that the host immune response plays a key role in pathogenesis.

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Low pressure hydrocephalus is a challenging diagnosis. The genesis of LPH was associated with a drop in EVD output, symptomatic ventriculomegaly, and a remarkable absence of intracranial hypertension. When LPH was treated with the sub-zero method, a 'diuresis' of CSF ensued. These observations support a Darcy's flux of brain interstitial fluid due to altered brain poroelastance; in simpler terms, a boggy brain state.

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Background:Cerebral venous sinus thrombosis (CVST) can cause elevated intracranial pressure, hemorrhagic venous infarct, and cortical subarachnoid hemorrhage. We present a case series and literature review to illustrate that CVST can also present with subdural hematoma (SDH).Case Description:Chart review was completed on a retrospective case series of CVST with spontaneous SDH. We also conducted a literature search. Over a 6 year interval, three patients with CVST and SDH were admitted to the neurointensive care unit. A 38-year-old woman had both SDH and a hemorrhagic venous infarct associated with a transverse sinus thrombosis. She was managed conservatively with long-term anticoagulation. A 68-year-old woman presented with an acute SDH requiring craniotomy and a thrombosed cortical vein was noted intraoperatively. Computed tomography venography showed thrombosis of the superior sagittal sinus. She had polycythemia vera with the V617 Jak2 gene mutation and was managed with aspirin and hydroxyurea. A 60-year-old male had recurrence of a spontaneous convexity SDH requiring reoperation. Neuroimaging identified ipsilateral transverse sinus thrombosis with retrograde flow into the opposite sinus. Manometry demonstrated elevated venous pressures and these normalized after thrombectomy. Angiography performed after endovascular treatment demonstrated a normal venous drainage pattern. There have been limited reports of SDH complicating CVST in the literature.Conclusion:This case series and literature review demonstrates that CVST can also present with spontaneous SDH with or without associated venous infarctions. Treatment must be individualized. This is the first published description of endovascular thrombectomy for recurrent symptomatic SDH due to CVST.

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