case_images: PMC10559507_01
case_images: Bifrontal hypoattenuating subdural collections on axial noncontrast computed tomography (CT) brain.
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case_images: F1
case_images: Imaging revealed bilateral hypoattenuating subdural collections with associated bifrontal sulcal effacement on CT [Figure 1].
case_images: (a) High-signal fluid collections on axial T2-weighted magnetic resonance imaging (MRI) brain. (b) Diffuse pachymeningeal enhancement on axial T1 post contrast MRI brain, indicative of intracranial hypotension.
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case_images: F2
case_images: MRI confirmed these to be fluid collections, with diffuse meningeal enhancement on T1-weighted sequences suggesting intracranial hypotension as the underlying cause [Figures 2a and b].
case_images: Sagittal T2-weighted magnetic resonance spine demonstrating anterior and posterior epidural fluid collections (red arrows) in the cervicothoracic region.
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case_images: F3
case_images: An MRI spine demonstrated epidural fluid collections in the cervicothoracic region [Figure 3].
case_images: Repeat computed tomography (CT) brain with increasing size of right-sided subdural collection.
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case_images: F4
case_images: An urgent CT brain exhibited enlarging subdural fluid collections, particularly on the right [Figure 4], with an increased local mass effect.
case_images: Magnetic resonance imaging brain (MRI) demonstrating (a) focal area of hyperintensity in the left pons on axial fluid attenuated inversion recovery and (b) corresponding diffusion restriction on diffusion-weighted imaging.
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case_images: F5
case_images: An up-to-date MRI brain [Figure 5] demonstrated a diffusion-restricting lesion in the left pons, with features concerning for an acute brainstem infarct.
case_images: Serial magnetic resonance imaging spines demonstrating steadily reducing epidural fluid collections (red arrows) on (a) day 1 postoperative (b) day 1 post first blood patch, and (c) day 1 post repeat blood patch.
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case_images: F6
case_images: GCS rose to 14 with successful extubation 2 days later. The cervicothoracic epidural fluid collections gradually reduced in volume over serial MRI [Figures 6a-c]. GCS improved to 15 and the patient was discharged 1 week after returning to the ward.