Risk Factors for Subdural Haematoma in Patients with Spontaneous Intracranial Hypotension

Abstract

Subdural haematoma (SDH) is a potentially life-threatening complication in patients with spontaneous intracranial hypotension (SIH). In serious cases, SIH patients who present with SDHs develop neurological deficits, a decreased level of consciousness, or cerebral herniation, and may even require an urgent neurosurgical drainage. Despite numerous publications on SDHs, few report its potential risk factors in patients with SIH. In this study, we retrospectively investigated 93 consecutive SIH patients and divided them into an SDH group (n = 25) and a non-SDH (NSDH) group (n = 68). The clinical and radiographic characteristics of these 93 patients were analyzed, and then univariate analysis and further multiple logistic regression analysis were performed to identify the potential risk factors for the development of SDHs. The univariate analysis showed that advanced age, male gender, longer clinical course, dural enhancement, and the venous distension sign were associated with the development of SDHs. However, multivariate analysis only included the latter three factors. Our study reveals important radiological manifestations for predicting the development of SDHs in patients with SIH.

Sex‐ and Age‐Related Differences in the Clinical and Neuroimaging Characteristics of Patients With Spontaneous Intracranial Hypotension: A Records Review

“…SDH on MR imaging was rare in younger and female patients than in older and male patients . Females and younger patients had more severe headache and earlier presentation to the hospital.…”

Misdiagnosis of Spontaneous Intracranial Hypotension as a Risk Factor for Subdural Hematoma

“…Several studies reported possible complications of SIH, such as cerebral venous thrombosis, intracranial aneurysm, and subdural hematoma . Among these complications, the relationship between SDH and SIH has long been controversial .…”

“…Our results are consistent with the previous studies. Xia et al reported that the longer clinical course was the risk factor of SDH in SIH patients (OR, 1.06; 95% CI, 1.02‐1.1). Chung et al also reported that patients in the SIH group complicated by SDH experienced delayed diagnosis (11.7 vs. 31.3 days; P = .019).…”

“…However, the exact cause of spontaneous spinal CSF leak and the natural course of SIH are not fully understood . Recently, increasing evidence indicates that SIH is more prevalent than expected and has potentially life‐threatening complications such as subdural hematoma (SDH) . A few studies have revealed that the delayed time from headache to diagnosis of SIH would negatively affect clinical outcomes, including SDH in patients with SIH …”

Massive subdural haematoma and dementia: a “yin and yang” paradigm

“…Axial and coronal non‐contrasted cerebral computed tomography images (Figure, A and B respectively) showed massive bi‐hemispheric acute (hyperdense) and chronic (hypodense) subdural haematoma, with extensive parenchymal compression. Dementia is strongly associated with brain atrophy and frequent falling, both of which are risk factors for subdural bleeding 1 caused by stretching and tearing of subdural veins 2 . The formation of a subdural haematoma can have further adverse effects in terms of cognitive decline.…”