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In clinical practice, reliable and quantitative diagnostic criteria for this condition are lacking. This study uses initial CT scans to identify novel radiographic markers for accurately diagnosing SIH-induced CSDH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 310 consecutives hospitalized CSDH cases from January 2008 to May 2023. Among these, 54 were bilateral, with 11 induced by SIH; two secondary intracranial hypotension cases were excluded. We analyzed nine primary SIH-induced cases, comparing clinical and preoperative CT features with 43 non-SIH bilateral cases, focusing on the parasagittal subdural space (PSS) volume. We also conducted propensity score matching to validate our findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with SIH-induced bilateral CSDH were significantly younger than those without SIH (mean age 54.7 vs. 76.2 years;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Orthostatic headache was more common in the SIH group (66.7% vs. 2.3%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). While hematoma volumes were similar, PSS volume was significantly larger in the SIH group (mean 15.0 vs. 5.1 mL,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.007). ROC analysis identified an exploratory PSS cut-off of 11.1\u00a0mm\u00b2, which yielded a sensitivity of 86% and a specificity of 66.7% (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.009). Linear regression and qualitative assessments indicated a significant association between PSS volume and crural-and-ambient cistern obliteration, as well as cerebellar ptosis in the SIH group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A preserved PSS on coronal CT represents a novel, quantitative marker for SIH-induced CSDH and may serve as a practical diagnostic clue, particularly when MRI is unavailable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12880-025-02065-6","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T17:05:07Z","timestamp":1767027907000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Parasagittal subdural space: a novel quantitative marker of spontaneous intracranial hypotension syndrome-induced chronic subdural hematoma"],"prefix":"10.1186","volume":"25","author":[{"given":"Takahiro","family":"Tanaka","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hajime","family":"Takase","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuya","family":"Haze","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wataru","family":"Shimohigoshi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitsuru","family":"Sato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tetsuya","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,29]]},"reference":[{"key":"2065_CR1","doi-asserted-by":"crossref","unstructured":"Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. 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