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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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