Bilateral Subdural Hematomas Caused by …

J Chin Med Assoc March 2008 Vol 71 No 3147 IntroductionSpontaneous intracranial hypotension (SIH) is causedby spontaneous cerebral spinal fluid (CSF) leakage ofunknown etiology at the level of the spine. Patientspresent with a new headache that occurs shortly afterassuming an upright position and is relieved by lyingdown (orthostatic headache). Although such a posi-tional headache pattern is well-known following a lum-bar puncture, SIH is not well recognized, and thepatient may be diagnosed with migraine, tensionheadache, viral meningitis, or malingering. The spon-taneous form of intracranial hypotension was firstdescribed in 1938, and much has been learned aboutthis syndrome, particularly since the early 1990s, butfrequent initial misdiagnosis SIH among physicians in general and the unusuallyvaried spectrum of clinical and radiographic manifes-tations may all contribute to a delay in diagnosis formonths or even most cases, SIH patients have typical orthosta-tic headaches that generally occur or worsen within15 minutes of assuming the upright position.

Case Report A 27-year-old male interior designer was well until he developed sudden onset of posterior neck pain radiating to bilateral shoulders after waking up …

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  Subdural, Waking up, Waking

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