case_images: PMC11799713_01
case_images: Computed tomography (CT) scans of the brain axial slices. (a) Initial scan showing bilateral subdural haematomas with marked midline shift to the left. (b) Day one postoperative CT scan showing adequate evacuation of the subdural haematomas. (c) Day 7 postoperative CT scan showing recurrent bilateral subdural collections. (d) CT scan 1 week and (e) CT scan 6 weeks
case_images: SNI-16-24-g001.jpg
case_images: PMC11799713_01_SNI-16-24-g001.jpg
case_images: F1
case_images: New areas of low attenuation in the right parietal, temporal, and occipital lobes were seen, suggesting infarcts [Figure 1].
case_images: Magnetic Resonance Imaging (MRI) brain showing (a and b) pachymeningeal thickening bilaterally, (c) cerebellar tonsillar herniation, pituitary congestion, flattening of pons, and (d) high T2 signal in the right hemipons indicative of acute infarct.
case_images: SNI-16-24-g002.jpg
case_images: PMC11799713_01_SNI-16-24-g002.jpg
case_images: F2
case_images: Smooth pachymeningeal thickening bilaterally, cerebellar tonsillar herniation, pituitary congestion, and flattening of pons were consistent with intracranial hypotension as the underlying cause of the SDHs [Figure 2].
case_images: (a) Magnetic resonance imaging (MRI) spine showing ventral longitudinal epidural collection from C2/3 to T2. (b) MRI spine 1 week after the targeted blood patch showed reduced size of the ventral epidural collection.
case_images: SNI-16-24-g003.jpg
case_images: PMC11799713_01_SNI-16-24-g003.jpg
case_images: F3
case_images: He was kept intubated and ventilated and underwent an MRI of the whole spine, which showed a ventral longitudinal epidural collection extending from C2/3 to T2, with features consistent with a CSF leak, including paucity of CSF around cauda equina and dilatation of lumbar venous plexus [Figure 3].
case_images: (a) Tuophy needle advanced to L1/2 epidural space. (b) Epidural position confirmed with contrast injection.
case_images: SNI-16-24-g004.jpg
case_images: PMC11799713_01_SNI-16-24-g004.jpg
case_images: F4
case_images: This demonstrated "dirty" opacification of the spinal canal, which confirmed the epidural position [Figure 4].