Prioritizing clinical indicators over radiological findings in the management of chronic subdural hematoma associated with spontaneous intracranial hypotension - 05/08/25
Highlights |
• | The authors analyzed 14 consecutive cases of spontaneous intracranial hypotension (SIH)-associated chronic subdural hematoma (CSDH). |
• | Patients with persistent headaches, papilledema, or altered consciousness underwent hematoma evacuation in addition to SIH treatment. |
• | Patients with positional headaches were successfully managed with SIH treatment alone. |
• | Clinical indicators such as headache type, papilledema, and altered consciousness may guide the need for hematoma evacuation in SIH-associated CSDH. |
• | Radiological findings alone, including hematoma size, may not be reliable indicators of the need for hematoma evacuation. |
Abstract |
Objective |
Chronic subdural hematoma (CSDH) is a well-documented imaging finding in spontaneous intracranial hypotension (SIH) and is often managed conservatively. While large hematomas identified on imaging traditionally prompt early surgical intervention, this approach still seems unclear. This study aims to clarify optimal management strategies by reviewing our clinical experience.
Methods |
We retrospectively analyzed 14 consecutive cases of CSDH associated with SIH treated at our institution between 2010 and 2024. Patient demographics, clinical symptoms, and imaging findings were extracted from medical records and statistically analyzed.
Results |
Seven patients with persistent headaches underwent hematoma drainage in addition to SIH treatment, whereas seven patients with positional headaches were successfully managed with SIH treatment alone. The persistent headache group had a larger median hematoma volume than the positional headache group (88.9 cm3 vs. 38.9 cm³). However, the persistent headache group had a significantly lower median Glasgow Coma Scale score than the positional headache group (13 vs. 15, p = 0.011). Papilledema was observed in five of the seven patients in the persistent headache group, but was absent in the positional headache group (p = 0.079).
Conclusions |
Our study demonstrates that clinical indicators—particularly papilledema, altered consciousness, and headache characteristics—are essential for guiding the need for hematoma drainage in CSDH associated with SIH. Radiological features such as hematoma volume were not sufficient predictors of surgical need.
Le texte complet de cet article est disponible en PDF.Keywords : Chronic subdural hematoma, Continuous epidural saline infusion, Epidural blood patch, Spontaneous intracranial hypotension
Abbreviations : CESI, CSDH, CSF, CT, EBP, GCS, ICHD, ICP, MRI, mRS, MWU, SIH
Plan
Vol 71 - N° 5
Article 101709- septembre 2025 Retour au numéro
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