{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T03:37:29Z","timestamp":1764733049499,"version":"3.41.2"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T00:00:00Z","timestamp":1710979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Spontaneous intracranial hypotension (SIH) is frequently complicated by subacute subdural hematoma (SDH) and more rarely by bilateral thalamic ischemia. Here, we report a case of SIH-related SDH treated with three epidural patches (EPs), with follow-up of the intracranial pressure and lumbar intrathecal pressure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A 46-year-old man presented bilateral thalamic ischemia, then a growing SDH. After failure of urgent surgical evacuation, he underwent three saline EPs, two dynamic myelography examinations and one digital subtraction angiography\u2013phlebography examination. However, because of no dural tear and no obstacle to the venous drainage of the vein of Galen, no therapeutic procedure was available, and the patient died.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The case exhibited a progressive increase in the transmission of lumbar intrathecal pressure to intracranial pressure during the three EPs. The EPs may have successfully treated the SIH, but the patient did not recover consciousness because of irreversible damage to both thalami.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Clinicians should be aware of the bilateral thalamic ischemia picture that may be the presenting sign of SIH. Moreover, the key problem in the pathophysiology of SIH seems to be intraspinal and intracranial volumes rather than pressures. Therefore, intracranial hypotension syndrome might actually be an intraspinal hypovolume syndrome.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2024.1308462","type":"journal-article","created":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T05:13:49Z","timestamp":1710998029000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Case report: Simultaneous measurement of intracranial pressure and lumbar intrathecal pressure during epidural patch therapy for treating spontaneous intracranial hypotension syndrome. Spontaneous intracranial hypotension or spontaneous intraspinal hypovolume?"],"prefix":"10.3389","volume":"15","author":[{"given":"Nicolas","family":"Engrand","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quentin","family":"Salardaine","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Philippe","family":"Desilles","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u00e9cile","family":"Echard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre","family":"Bourdillon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Williams","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guillaume","family":"Baille","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,3,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.wneu.2016.09.076","article-title":"Value 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systematic review and Meta-analysis","volume":"78","author":"D\u2019Antona","year":"2021","journal-title":"JAMA Neurol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e242","DOI":"10.1016\/j.wneu.2020.01.163","article-title":"Epidural blood patch as a diagnostic and therapeutic intervention in spontaneous intracranial hypotension: a novel approach to management","volume":"137","author":"Davies","year":"2020","journal-title":"World Neurosurg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1145949","DOI":"10.3389\/fneur.2023.1145949","article-title":"Diagnosis and treatment evaluation in patients with spontaneous intracranial hypotension","volume":"14","author":"Mehta","year":"2023","journal-title":"Front Neurol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1034\/j.1600-0404.2001.00141.x","article-title":"Bilateral thalamic infarction. Clinical, etiological and MRI correlates","volume":"103","author":"Kumral","year":"2001","journal-title":"Acta Neurol Scand"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1177\/0333102417690106","article-title":"Intracranial structural alteration predicts treatment outcome in patients with spontaneous intracranial hypotension","volume":"38","author":"Choi","year":"2018","journal-title":"Cephalalgia"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"760081","DOI":"10.3389\/fneur.2021.760081","article-title":"Spontaneous intracranial hypotension without CSF leakage-concept of a pathological cranial to spinal fluid shift","volume":"12","author":"Goldberg","year":"2021","journal-title":"Front Neurol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"93","DOI":"10.2176\/jns-nmc.2022-0356","article-title":"Two cases of chronic subdural hematoma with spontaneous intracranial Hypotention treated with hematoma drainage followed by epidural blood patch under intracranial pressure monitoring","volume":"10","author":"Terakado","year":"2023","journal-title":"NMC Case Rep J"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1093\/bja\/aer186","article-title":"Increase in optic nerve sheath diameter induced by epidural blood patch: a preliminary report","volume":"107","author":"Dubost","year":"2011","journal-title":"Br J Anaesth"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e200137","DOI":"10.1212\/CPJ.0000000000200137","article-title":"Rescue epidural saline patch for comatose patients with refractory convexity spontaneous subacute subdural hematoma: case report","volume":"13","author":"Roy","year":"2023","journal-title":"Neurol Clin Pract"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/j.neurol.2008.05.006","article-title":"Treatment of spontaneous intracranial hypotension by epidural saline infusion","volume":"165","author":"Rouaud","year":"2009","journal-title":"Rev Neurol (Paris)"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1308462\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T05:13:52Z","timestamp":1710998032000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1308462\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,21]]},"references-count":19,"alternative-id":["10.3389\/fneur.2024.1308462"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2024.1308462","relation":{},"ISSN":["1664-2295"],"issn-type":[{"type":"electronic","value":"1664-2295"}],"subject":[],"published":{"date-parts":[[2024,3,21]]},"article-number":"1308462"}}