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A 38-year-old woman with no prior medical history presented with an acute-onset orthostatic headache that worsened when upright and improved with recumbency. She was fully conscious and neurological examination was normal (pupils equally reactive). MR scan of brain showed bilateral subdural haematomas (19 mm right, 10 mm left) without midline shift, supporting a clinical suspicion of spontaneous intracranial hypotension (figure 1). Non-contrast MR scan of whole spine found no cerebrospinal fluid (CSF) leak.
A non-targeted epidural blood patch comprising 40 mL autologous blood was performed and followed immediately by a syncopal episode. On regaining consciousness, her headache had improved with abolition of the positional element, …
Contributors HM was involved in the patient’s care, drafted the manuscript and obtained patient consent. RNdS was responsible for editing and reviewing the manuscript. NM was involved in the patient’s care and involved in review of the manuscript. SC was involved in the patient’s care and involved in data collection.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned. Externally peer reviewed by Paul Kopanidis, Sydney, Australia.