{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T21:45:28Z","timestamp":1749764728435},"reference-count":10,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground: <\/jats:title>\nWe present a unique case of spontaneous intracranial hypotension (SIH) presenting with acute collapse and loss of consciousness.<\/jats:p>\n<\/jats:sec>\n\nCase Description: <\/jats:title>\nThe affected patient suffered an abrupt decline in level of consciousness several weeks after initial diagnosis. The patient was urgently transferred to a specialist neurosurgical unit. Imaging showed bilateral subdural fluid collections with significant associated local mass effect. The treating team faced a clinical conundrum with a lack of clarity as to whether this sudden deterioration was secondary to the local pressure effect on brainstem traction from reduced intracranial pressure. A decision was made to proceed with urgent burr-hole decompression of the bilateral subdural fluid collections.<\/jats:p>\n<\/jats:sec>\n\nConclusion: <\/jats:title>\nAfter a protracted, complex postoperative course, the patient recovered to full functional independence. To the author\u2019s knowledge, this is the first case in literature describing successful surgical management of SIH, with bilateral burr-hole evacuation to relieve the paradoxical mass effect of bilateral subdural fluid collections.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_293_2023","type":"journal-article","created":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T11:31:27Z","timestamp":1694777487000},"page":"338","update-policy":"http:\/\/dx.doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["When does too little pressure become too much? A case of spontaneous intracranial hypotension presenting with acute loss of consciousness"],"prefix":"10.25259","volume":"14","author":[{"given":"Conor","family":"Brosnan","sequence":"first","affiliation":[{"name":"Department of Radiology, Beaumont Hospital, Dublin 9, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed Osman","family":"Dablouk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland"},{"name":"Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Healy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland"},{"name":"Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Murray","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland"},{"name":"Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamzah A.","family":"Soleiman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ciaran","family":"Bolger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland"},{"name":"Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2023,9,15]]},"reference":[{"key":"10.25259\/SNI_293_2023\/ref-1","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.3174\/ajnr.A4706","article-title":"Atypical presentations of intracranial hypotension: Comparison with classic spontaneous intracranial hypotension","volume":"37","author":"Capizzano","year":"2016","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_293_2023\/ref-2","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1177\/0333102415585095","article-title":"Treatment and prognosis of subdural hematoma in patients with spontaneous intracranial hypotension","volume":"36","author":"Chen","year":"2016","journal-title":"Cephalalgia"},{"key":"10.25259\/SNI_293_2023\/ref-3","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1001\/jamaneurol.2020.4799","article-title":"Clinical presentation, investigation findings, and treatment 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hypotension","volume":"43","author":"Lin","year":"2002","journal-title":"Acta Radiol"},{"key":"10.25259\/SNI_293_2023\/ref-7","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/S1607-551X(09)70008-7","article-title":"Burr hole drainage for complicated spontaneous intracranial hypotension syndrome","volume":"24","author":"Liu","year":"2008","journal-title":"Kaohsiung J Med Sci"},{"key":"10.25259\/SNI_293_2023\/ref-8","doi-asserted-by":"crossref","first-page":"615","DOI":"10.3171\/2012.4.JNS112030","article-title":"Intracranial hypotension producing reversible coma: A systematic review, including three new cases","volume":"117","author":"Loya","year":"2012","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_293_2023\/ref-9","doi-asserted-by":"crossref","first-page":"853","DOI":"10.3174\/ajnr.A0956","article-title":"Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension","volume":"29","author":"Schievink","year":"2008","journal-title":"AJNR Am J 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