Chronic Subdural Hematoma Masquerading as Intracranial Hypotension

Spontaneous intracranial hypotension (SIH) is caused by cerebrospinal fluid leak and has an incidence of approximately five per 100,000 person-years. SIH leads to a range of clinical symptoms, from debilitating postural headaches to subdural hematomas (SDHs). The pathophysiology of the disease is not fully understood, but has garnered interest in recent years. Although CT myelogram and pan-spine MRIs are currently considered the gold standard for diagnosis of SIH, the variable sensitivity (48-76%) and wide range of hematoma size (2-30 mm) warrant further investigation into improved diagnostic and treatment options. We present the case of a patient with non-traumatic bilateral SDHs and clinical findings suggestive of intracranial hypotension and CSF leak. The patient initially presented with typical signs and symptoms of SIH and resulting SDH. However, her clinical course was highly unusual given the sudden resolution of her symptoms despite receiving interventions that were not believed to have repaired the underlying pathology. This unique presentation of an SDH encourages the need for larger prospective studies of patients with SIH and SDH and the exploration of the role and efficacy of middle meningeal artery (MMA) embolization. This procedure is a new and promising treatment for SDH regardless of the etiology.