[Spontaneous intracranial hypotension manifesting as sudden deafness followed by chronic subdural hematoma]

We report a case of spontaneous intracranial hypotension (SIH) manifesting as sudden deafness followed by chronic subdural hematoma in the course of the disease. The patient was a 31-year-old female presenting with an orthostatic headache. Judging from her characteristic symptoms, SIH was strongly suggested. MR images with gadolinium were consistent with the diagnosis of SIH with a diffuse dural enhancement. Her symptoms improved gradually by conservative therapies with bed rest and oral steroid, but she developed poor hearing at 3 weeks after the onset of the symptoms. She was diagnosed as having sudden deafness. After altering the therapeutic modality to intravenous steroid administration, her perceptive deafness resolved earlier, and her symptoms of headache disappeared. However, she was readmitted to our hospital at 4 months after the onset, complaining of the aggravation of headache with a different type, which was worse in the recumbent posture. Follow-up MR images revealed a development of subdural hematoma with mass effect, and the hematoma had to be treated by burr hole drainage. In this case, the site of CSF leakage along the spinal axis was not identified by spinal MR images. This case is considered to be a rare one, complicating sudden deafness followed by chronic subdural hematoma during the clinical course of the SIH.