case_images: PMC10962535_01
case_images: (A, B) Brain CT on Day 1 of hospitalization showed a slit ventricle (black arrowhead) and saggy brain with basal cistern obliteration (black arrow). (C, D) Brain CT on Day 3 of hospitalization showed bilateral subdural fluid collection (white arrowhead) with mass effect. (E) Non-contrast brain MRI T1-weighted image showed bilateral subdural fluid collection. (F) Contrast brain MRI T1-weighted image showed pachymeningeal enhancement (white arrow).
case_images: bmed-13-04-051f1.jpg
case_images: PMC10962535_01_bmed-13-04-051f1.jpg
case_images: f1-bmed-13-04-051
case_images: Brain computed tomography (CT) revealed a slit ventricle and a crowded suprasellar cistern (Fig. 1). Brain CT and magnetic resonance imaging (MRI) scans were performed, which showed bilateral subdural hematoma on the CT scan and diffuse pachymeningeal enhancement with subdural fluid collection on the MRI scan (Fig. 1).
case_images: (A) Remarkable thickened dura under intraoperative endoscopic view with (B) some connection between the dura and brain surface. (C) Fibrosis and focal fibrinoid exudate admixed with mild lymphocytes in the dura mater.
case_images: bmed-13-04-051f2.jpg
case_images: PMC10962535_01_bmed-13-04-051f2.jpg
case_images: f2-bmed-13-04-051
case_images: During the dural opening, a thickened dura mater was noted (Fig. 2), and a leptomeningeal biopsy was performed. Microscopic examination revealed marked fibrosis and focal fibrinoid exudate mixed with mild lymphocytes (Fig. 2).
case_images: (A) MR sagittal image shows the dura (white arrows) located between the CSF at the T1 to T12 levels. (B) MR axial view shows epidural CSF collection (white arrow heads). (C, D, E, F) Thoracic CT myelography shows contrast leakage at the T5 to T8 levels on the right side (black arrows). (G) The thoracic spine sagittal T2weighted image 6 months after treatment shows no more epidural fluid collection. (H) The thoracic spine MRI axial image 6 months after treatment shows no more epidural fluid collection. (I, J) The brain MRI image 6 months after treatment shows no more subdural fluid collection.
case_images: bmed-13-04-051f3.jpg
case_images: PMC10962535_01_bmed-13-04-051f3.jpg
case_images: f3-bmed-13-04-051
case_images: Thoracic spine MRI showed abnormal fluid collection in the posterior epidural space from the T2 to T12 levels (Fig. 3). T5 to T8 levels, and multiple high-flow CSF leakages were suspected (Fig. 3). Therefore, an autologous epidural blood patch (EBP) with 20 ml was injected into the T8 level on Day 9 of hospitalization. Six months later, brain CT and thoracic spine MRI (Fig. 3) were normal, and no SIH recurrence was observed at the six-year follow-up.