Coma from worsening spontaneous intracranial hypotension after subdural hematoma evacuation

Amandeep K. Dhillon, Alejandro A. Rabinstein, Eelco F.M. Wijdicks

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Background Low cerebrospinal fluid volume is typically diagnosed in patients presenting with positional headaches. However, severe intracranial hypotension and brain sagging may cause orthostatic coma. We present a case that illustrates this uncommon presentation. Method Case report. Results A 50-year-old man presented with orthostatic headaches and then developed bilateral subdural hematomas. Following unilateral subdural hematoma evacuation, the patient became gradually drowsier and more confused. Upon transfer to our hospital, he would become comatose each time he was placed in the upright position. Successful epidural patch at the level of a spontaneous cerebrospinal fluid leak documented by myelography resulted in complete resolution of his orthostatic symptoms despite reaccumulation of the subdural fluid collection. Conclusions Evacuation of subdural fluid collections may be detrimental in patients with low CSF volume by exacerbating the intracranial hypotension. Extreme brain sagging may lead to anatomical distortion of the diencephalon and brainstem resulting in coma.

Original languageEnglish (US)
Pages (from-to)390-394
Number of pages5
JournalNeurocritical care
Issue number3
StatePublished - Jun 2010


  • CSF leak
  • Low CSF volume
  • Orthostatic coma
  • Spontaneous intracranial hypotension
  • Subdural hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine


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