Experience in diagnosis and treatment of spontaneous intracranial hypotension with cerebral venous thrombosis and subdural hematoma: one case report

Abstract

Objective To report a case of spontaneous intracranial hypotension (SIH) with cerebral venous thrombosis (CVT) and subdural hematoma (SDH), summarize its clinical manifestations and imaging features, and improve clinicians' ability of diagnosis and differential diagnosis, as well as the recognition of the related complications. Methods and Results The patient was a 56⁃year⁃old male with a subacute to chronic disease course, with the onset of orthostatic headache, progressive exacerbation, and developed numbness and weakness in the right limb. Imaging findings revealed diffuse enhancement of dura mater, bilateral chronic SDH and CVT. After rehydration, anticoagulation, mechanical thrombectomy and thrombolytic therapy, the CVT was significantly reduced. Due to the continuous increasion in bleeding tendency and the expansion of SDH, after discontinuation of anticoagulant and craniotomy for hematoma removal, the condition was controlled, and the volume of SDH decreased. Follow⁃up 3 months after discharge, head MRI showed that there was basically no filling defect in the venous sinus, and the visualization was significantly improved; the patient's orthostatic headache disappeared, and no focal neurological dysfunction remained. Conclusions Although SIH with cerebral venous system thrombosis and SDH, treated by fluid replacement, anticoagulation, and endovascular treatment, the symptoms and signs induced by venous thrombosis can be improved, these measures can't prevent the further expansion of the SDH, early detection of leaks and repairs may be more conducive to the recovery.

doi：10.3969/j.issn.1672⁃6731.2022.06.008