Clinical Features of Patients With Spontaneous Intracranial Hypotension Complicated With Bilateral Subdural Fluid Collections

Abstract

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.

Two Cases of Chronic Subdural Hematoma with Spontaneous Intracranial Hypotention Treated with Hematoma Drainage Followed by Epidural Blood Patch Under Intracranial Pressure Monitoring

“…Some clues that may suggest SIH-associated CSDH are age < 55 years, no underlying disease, a small amount of hematoma, brain-sag, and pseudo-subarachnoid hemorrhage. 13) Treatment methods and procedures differ depending on the individual's condition. Some cases of SIH-associated CSDH were resolved after EBP alone.…”

“…Some clues that may suggest SIH-associated CSDH are age < 55 years, no underlying disease, a small amount of hematoma, brain-sag, and pseudo-subarachnoid hemorrhage. 13 )…”

Bilateral post-traumatic hygromas in patient with frontotemporal dementia

“…There are few cases of bilateral hygromas described in the literature, nevertheless none of these is related to severe frontotemporal cortex bilateral atrophy. Bilateral hygromas are often found in spontaneous intracranial hypotension (SIH),[ 9 , 17 ] but in the case, we described there were no obvious neurological signs of SIH or radiological signs such as CSF leakage through dural defects, reduction in CSF volume or leptomeningeal enhancement after gadolinium administration. [ 2 ] In rare cases, subdural hygromas may be secondary to resorption and/or liquefaction phenomena of a primitive subdural hematoma (Virchow’s hygromas), characterized by elevated concentration of albumin which remains an important predictive value, useful for the differential diagnosis.…”

Acute subdural hematoma recurrence during drain removal associated with spontaneous intracranial hypotension – A non-reported complication

“…Patients with SIH will most likely be younger (median age of 40) and have additional findings on CT scans such as brain sagging and pseudo-subarachnoid hemorrhage features. [ 8 ]…”