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Case Report

Spontaneous intracranial hypotension complicated

with cerebral venous thrombosis and subdural

effusion: a case report

1
Murali Krishna Menon , Thara Prathap , Muhammed Jasim Abdul Jalal 3
2
1 Department of Neurology, Lakeshore Hospital and Research Centre, Ernakulam 682040, Kerala, India.
2 Department of Radiology, Lakeshore Hospital and Research Centre, Ernakulam 682040, Kerala, India.
3 Department of Family Medicine, Lakeshore Hospital and Research Centre, Ernakulam 682040, Kerala, India.

Dr. Muhammed Jasim Abdul Jalal, a family physician, trained in general medicine,
general surgery, women and child health and preventive medicine. He believes in the
concept of medical care with a preventive and holistic approach. He has special interest
in clinical neurology.

A B S T R AC T
Spontaneous intracranial hypotension treatment can be complicated by concomitant cerebral venous thrombosis and subdural
hematoma. A 48 years old male, presenting orthostatic headache and neck pain for 1 month displayed sagittal sinus thrombosis and
bilateral subdural effusions, as well as extradural fluid collection at T3-T8 level, upon magnetic resonance imaging. Cerebrospinal
fluid opening pressure was 50 mmH O, and a leak was confirmed at C2-C3 level by computed tomography (CT) myelogram. The
2
presence of subdural hematoma precluded anticoagulation treatments. An autologous epidural blood patch at C2-C3 level under
CT guidance improved the patient’s condition, remaining free of residual symptoms or recurrence at six-month follow-up.
Key words: Spontaneous intracranial hypotension; cerebral venous thrombosis; subdural effusion; autologous epidural blood
patch

INTRODUCTION pleocytosis.

Orthostatic headache, low cerebrospinal fluid (CSF) SIH cases occasionally present with concomitant
pressure, and noninterrupted diffuse pachymeningeal subdural effusions and, more rarely, cerebral venous
[3]
enhancement observed upon magnetic resonance thrombosis (CVT) (2% of patients). The most
imaging (MRI) of the brain, characterize spontaneous characteristic brain MRI finding in SIH is diffuse
intracranial hypotension (SIH). The estimated pachymeningeal enhancement, that is caused by an
increase in venous blood volume secondary to the loss
annual incidence of this uncommon disorder is 5 per of CSF pressure. This alteration can lead to subdural
[4]
100,000, and its cause lies in spontaneous CSF leaks hematoma and CVT through two main mechanisms:
that result in CSF hypovolemia and hypotension (CSF (1) SIH is associated with rostrocaudal sagging of the
opening pressure < 60 mmH O). CSF composition [4]
[1]
2 brain due to the loss of CSF buoyancy, resulting in
may be normal or show increased protein content and a negative intracranial pressure gradient that may
damage the venous endothelial lining by stretching
Corresponding Author: Dr. Muhammed Jasim Abdul Jalal,
Department of Family Medicine, Lakeshore Hospital and the cerebral vessels, and can produce tears in bridging
Research Centre, Nettoor.P.O., Maradu, NH 47-Byepass.
Ernakulam 682040, Kerala, India. E-mail: poolspuff@gmail.com This is an open access article distributed under the terms of the Creative
Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
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How to cite this article: Menon MK, Prathap T, Jalal MJA. Spontaneous
intracranial hypotension complicated with cerebral venous thrombosis
and subdural effusion: a case report. Neuroimmunol Neuroinflammation
DOI:
10.20517/2347-8659.2015.35 2016;3:104-8.
Received: 06-09-2015; Accepted: 05-12-2015

104 © 2016 Neuroimmunology and Neuroinflammation | Published by OAE Publishing Inc.