RECURRENCE OF SPONTANEOUS INTRACRANIAL HYPOTENSION WITH SUBDURAL HEMATOMAS

A 59-year-old man developed postural headache associated with a low CS F pressure. A CT scan revealed no abnormal findings and the orthostati c symptoms resolved without treatment 6 weeks after onset. He was diag nosed as having spontaneous intracranial hypotension (SIH) and remaine d symptom-free until he experienced recurrence of postural headache 9 months later. A lumbar puncture demonstrated low CSF pressure, and a C T scan revealed slit-like ventricles with narrowing of the sulci, Sylv ian fissures, and infratentorial cisterns, in addition to bilateral su bdural masses. After draining the hematomas, his symptoms resolved com pletely, and a follow-up CT scan was normal. We hypothesize that recur rent SIH in this case was due to small recurrent tears of a root sleev e. This case emphasizes the importance of follow-up of SM for at least 9 months after resolution of symptoms.