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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2021; 10(01): 006-012
DOI: 10.1055/s-0040-1721203
Review Article

Recurrent Spontaneous Bilateral Subdural Hemorrhage as a Consequence of High-Cervical Spontaneous CSF Leak—Lessons for Neurosurgeons

Venugopal Subramaniam
1   Department of Neurosurgery, Manipal Hospital Whitefield, Bangalore, Karnataka, India
,
Sibhi Ganapathy 
1   Department of Neurosurgery, Manipal Hospital Whitefield, Bangalore, Karnataka, India
,
S. Shivananda
2   Department of Anesthesiology, Manipal Hospital Whitefield, Bangalore, Karnataka, India
,
K. N. Nagabhushan
3   Department of Radiodiagnostics, Manipal Hospital Whitefield, Bangalore, Karnataka, India
,
Raghu Murthy
3   Department of Radiodiagnostics, Manipal Hospital Whitefield, Bangalore, Karnataka, India
› Author Affiliations Funding None.
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Abstract

Spontaneous intracranial hypotension (SIH) is rare. It presents as intractable posture headache and is identified by radiological findings. It is confirmed by cerebrospinal fluid (CSF) manometry and myelography, and treatment is carried out with the help of epidural blood patch (EBP) therapy. SIH presenting with spontaneous bilateral recurrent subdural bleeds is uncommon. The cause being a high-spinal CSF leak is even more uncommon! Our patient had recurrent bilateral spontaneous chronic subdural hematomas. Myelographic examination of the spine showed a C1–C2 level leak of CSF. He was taken up for open microsurgery, and the leak was identified and closed with fibrin glue. The patient however deteriorated the next day. An EBP was applied in the lumbar region to cover the myelogram lumbar puncture site. We present a review of literature and an algorithm to detect the elusive CSF leak and effect definitive treatment, either open or EBP, to treat the source of the problem.

Keywords

spontaneous intracranial hypotension - recurrent subdural hematomas - bilateral subdural hematomas - spontaneous spinal dural leaks


Publication History

Article published online:
25 January 2021

© 2021. Neurological Surgeons’ Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Amorim JA, Remígio DS, Damázio Filho O, de Barros MA, Carvalho VN, Valença MM. Intracranial subdural hematoma post-spinal anesthesia: report of two cases and review of 33 cases in the literature. Rev Bras Anestesiol 2010; 60 (06) 620-629, 344–349
    CrossrefPubMedGoogle Scholar
  • 2 Beier AD, Soo TM, Claybrooks R. Subdural hematoma after microdiscectomy: a case report and review of the literature. Spine J 2009; 9 (10) e9-e12
    CrossrefPubMedGoogle Scholar
  • 3 Cohen-Gadol AA, Mokri B, Piepgras DG, Meyer FB, Atkinson JL. Surgical anatomy of dural defects in spontaneous spinal cerebrospinal fluid leaks. Neurosurgery 2006; 58 (04) , Suppl 2) ONS-238-ONS-245, discussion ONS-245
    PubMedGoogle Scholar
  • 4 Forster MT, Mathé AK, Senft C, Scharrer I, Seifert V, Gerlach R. The influence of preoperative anticoagulation on outcome and quality of life after surgical treatment of chronic subdural hematoma. J Clin Neurosci 2010; 17 (08) 975-979
    CrossrefPubMedGoogle Scholar
  • 5 Gardner WJ. Traumatic subdural hematoma: with particular reference to the latenl interval. Arch Neurol Psychiatry 1932; 27: 847-858
    CrossrefPubMedGoogle Scholar
  • 6 Gaucher Jr DJ, Perez Jr JA. Subdural hematoma following lumbar puncture. Arch Intern Med 2002; 162 (16) 1904-1905
    CrossrefPubMedGoogle Scholar
  • 7 Ishihara H, Ishihara S, Kohyama S. et al. Experience in endovascular treatment of recurrent chronic subdural hematoma. Interv Neuroradiol 2007; 13 (Suppl. 01) 141-144
    CrossrefPubMedGoogle Scholar
  • 8 Ko BS, Lee JK, Seo BR, Moon SJ, Kim JH, Kim SH. Clinical analysis of risk factors related to recurrent chronic subdural hematoma. J Korean Neurosurg Soc 2008; 43 (01) 11-15
    CrossrefPubMedGoogle Scholar
  • 9 Langdown AJ, Grundy JR, Birch NC. The clinical relevance of Tarlov cysts. J Spinal Disord Tech 2005; 18 (01) 29-33
    CrossrefPubMedGoogle Scholar
  • 10 Markwalder TM. Chronic subdural hematomas: a review. J Neurosurg 1981; 54 (05) 637-645
    CrossrefPubMedGoogle Scholar
  • 11 Mori K, Maeda M. Risk factors for the occurrence of chronic subdural haematomas after neurosurgical procedures. Acta Neurochir (Wien) 2003; 145 (07) 533-539, discussion 539–540
    CrossrefPubMedGoogle Scholar
  • 12 Mori K, Maeda M. Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo) 2001; 41 (08) 371-381
    CrossrefPubMedGoogle Scholar
  • 13 Oishi M, Toyama M, Tamatani S, Kitazawa T, Saito M. Clinical factors of recurrent chronic subdural hematoma. Neurol Med Chir (Tokyo) 2001; 41 (08) 382-386
    CrossrefPubMedGoogle Scholar
  • 14 Putnam TJ, Cushing H. Chronic subdural hematoma: its pathology, its relation to pachymeningitis hemorrhagica and its surgical treatment. Arch Surg 1925; 11: 329-393
    CrossrefPubMedGoogle Scholar
  • 15 Buvanendran A, Byrne RW, Kari M, Kroin JS. Occult cervical (C1-2) dural tear causing bilateral recurrent subdural hematomas and repaired with cervical epidural blood patch. J Neurosurg Spine 2008; 9 (05) 483-487
    CrossrefPubMedGoogle Scholar
  • 16 Chen HH, Huang CI, Hseu SS, Lirng JF. Bilateral subdural hematomas caused by spontaneous intracranial hypotension. J Chin Med Assoc 2008; 71 (03) 147-151
    CrossrefPubMedGoogle Scholar
  • 17 Cousins MJ, Brazier D, Cook R. Intracranial hypotension caused by cervical cerebrospinal fluid leak: treatment with epidural blood patch. Anesth Analg 2004; 98 (06) 1794-1797
    CrossrefPubMedGoogle Scholar
  • 18 Dillo W, Hollenhorst J, Brassel F. von Hof-Strobach K, Heidenreich F, Johannes S. Successful treatment of a spontaneous cervical cerebrospinal fluid leak with a CT guided epidural blood patch. J Neurol 2002; 249 (02) 224-225
    CrossrefPubMedGoogle Scholar
  • 19 Fishman RA, Dillon WP. Dural enhancement and cerebral displacement secondary to intracranial hypotension. Neurology 1993; 43 (3 Pt 1) 609-611
    CrossrefPubMedGoogle Scholar
  • 20 Inamasu J, Nakatsukasa M. Blood patch for spontaneous intracranial hypotension caused by cerebrospinal fluid leak at C1-2. Clin Neurol Neurosurg 2007; 109 (08) 716-719
    CrossrefPubMedGoogle Scholar
  • 21 Mokri B. The Monro-Kellie hypothesis: applications in CSF volume depletion. Neurology 2001; 56 (12) 1746-1748
    CrossrefPubMedGoogle Scholar
  • 22 Mokri B, Maher CO, Sencakova D. Spontaneous CSF leaks: underlying disorder of connective tissue. Neurology 2002; 58 (05) 814-816
    CrossrefPubMedGoogle Scholar
  • 23 Nardone R, Caleri F, Golaszewski S. et al. Subdural hematoma in a patient with spontaneous intracranial hypotension and cerebral venous thrombosis. Neurol Sci 2010; 31 (05) 669-672
    CrossrefPubMedGoogle Scholar
  • 24 Pannullo SC, Reich JB, Krol G, Deck MD, Posner JB. MRI changes in intracranial hypotension. Neurology 1993; 43 (05) 919-926
    CrossrefPubMedGoogle Scholar
  • 25 Rando TA, Fishman RA. Spontaneous intracranial hypotension: report of two cases and review of the literature. Neurology 1992; 42 (3 Pt 1) 481-487
    CrossrefPubMedGoogle Scholar
  • 26 Rai A, Rosen C, Carpenter J, Miele V. Epidural blood patch at C2: diagnosis and treatment of spontaneous intracranial hypotension. AJNR Am J Neuroradiol 2005; 26 (10) 2663-2666
    PubMedGoogle Scholar
  • 27 Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 2006; 295 (19) 2286-2296
    CrossrefPubMedGoogle Scholar
  • 28 Vaidhyanath R, Kenningham R, Khan A, Messios N. Spontaneous intracranial hypotension: a cause of severe acute headache. Emerg Med J 2007; 24 (10) 739-741
    CrossrefPubMedGoogle Scholar
  • 29 Bousser MG. [Headache in spontaneous cerebrospinal fluid hypotension]. Rev Neurol (Paris) 2005; 161 (6-7) 700-702
    CrossrefPubMedGoogle Scholar