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An overlooked cause of subdural effusions
Yan-Lin Li1,2, Chi Sum Tsang2
1Department of Radiology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong.
BMJ Case Reports
|August 9, 2017
Summary
Misinterpreted subdural effusions in a patient with progressive confusion were due to intracranial hypotension from spinal cerebrospinal fluid leakage. Prompt diagnosis and conservative treatment led to full neurological recovery.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Progressive confusion can indicate serious neurological conditions.
- Subdural effusions are often associated with various intracranial pathologies.
- Cerebrospinal fluid (CSF) leakage can lead to intracranial hypotension.
Observation:
- A middle-aged man presented with progressive confusion and was initially misdiagnosed with cerebral atrophy and subdural effusions on CT scan.
- The patient experienced acute neurological deterioration, necessitating surgical intervention for presumed subdural effusions.
Findings:
- The effusions were confirmed to be secondary to intracranial hypotension caused by a spinal CSF leak.
- Burr hole drainage was performed, but the underlying cause was CSF leakage.
Implications:
- This case highlights the importance of considering intracranial hypotension in patients with apparent subdural effusions and neurological decline.
- Accurate diagnosis of CSF leakage is crucial for effective treatment and preventing neurological sequelae.
- Conservative management, including bed rest and hydration, can be effective for intracranial hypotension secondary to CSF leaks.
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