{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T04:49:21Z","timestamp":1770353361785,"version":"3.49.0"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","license":[{"start":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T00:00:00Z","timestamp":1675641600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,6]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Spontaneous intracranial hypotension (SIH) is a relatively rare and underdiagnosed disease. SIH can lead to subdural hematomas (SDHs) and other complications. SDHs secondary to SIH are difficult to manage, with no consensus in management, and SDHs commonly recur if underlying SIH is not treated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 46-year-old male with vague sensory and orientation symptoms presented with bilateral SDHs, which were treated with middle meningeal artery (MMA) embolization and burr hole evacuation. The patient improved initially but had recurrent encephalopathy and SDHs. The patient received 3 epidural blood patches (EBPs) over 8 days with continued improvement. A 78-year-old female presented with headaches, and imaging revealed a left chronic SDH. She underwent MMA embolization and mini-craniotomy for SDH evacuation. Her symptoms returned and imaging revealed a recurrent SDH. Pan spine computed tomography myelography showed a high thoracic cerebrospinal fluid (CSF) leak. She underwent 3 EBPs over 8 days with neurological improvement and stabilization of her SDH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>The authors show that, if SDH recurs after initial treatment with MMA embolization, then SIH should be strongly considered and treated with EBPs. Further investigation is required to determine the role of targeted or blind EBPs and the use of imaging to find the source of occult CSF leaks causing SIH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case22445","type":"journal-article","created":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T07:38:18Z","timestamp":1675669098000},"source":"Crossref","is-referenced-by-count":1,"title":["Discovering spontaneous intracranial hypotension after failed middle meningeal artery embolization for subdural hematomas: illustrative cases"],"prefix":"10.3171","volume":"5","author":[{"given":"Lokeshwar S.","family":"Bhenderu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcus","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gavin","family":"Britz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"9","key":"b1","series-title":"Neurol Sci","first-page":"2433","article-title":"Spontaneous intracranial hypotension: key features for a frequently misdiagnosed disorder","volume":"41","author":"Perez-Vega C","year":"2020","unstructured":"Perez-Vega C, Robles-Lomelin P, Robles-Lomelin I, Garcia Navarro V. 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Korean J Neurotrauma. 2020;16(2):254\u2013261."},{"issue":"10","key":"b3","series-title":"Headache","first-page":"1593","article-title":"Misdiagnosis of spontaneous intracranial hypotension as a risk factor for subdural hematoma","volume":"57","author":"Kim YJ","year":"2017","unstructured":"Kim YJ, Cho HY, Seo DW,  Misdiagnosis of spontaneous intracranial hypotension as a risk factor for subdural hematoma. Headache. 2017;57(10):1593\u20131600."},{"issue":"1","key":"b4","series-title":"Case Rep Neurol","first-page":"71","article-title":"Spontaneous intracranial hypotension manifesting as a unilateral subdural hematoma with a marked midline shift","volume":"7","author":"Inamasu J","year":"2015","unstructured":"Inamasu J, Moriya S, Shibata J, Kumai T, Hirose Y. Spontaneous intracranial hypotension manifesting as a unilateral subdural hematoma with a marked midline shift. 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