TY - JOUR
T1 - Clinical Features of Patients With Spontaneous Intracranial Hypotension Complicated With Bilateral Subdural Fluid Collections
AU - Kim, Jang Hun
AU - Roh, Haewon
AU - Yoon, Won Ki
AU - Kwon, Taek Hyun
AU - Chong, Kyuha
AU - Hwang, Soon Young
AU - Kim, Jong Hyun
N1 - Funding Information:
Conflict of Interest: The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Financial Support: This study was supported by a Korean National Research Foundation (NRF) Grant.
Funding Information:
Acknowledgment: This work was supported by the National Research Foundation (NRF) grant funded by the Government of Republic of Korea (MSIT): 2017R1D-1A1B03036357.
Publisher Copyright:
© 2019 American Headache Society
PY - 2019/5
Y1 - 2019/5
N2 - Background: Subdural hygromas are often found bilaterally in spontaneous intracranial hypotension (SIH). They frequently progress to chronic subdural hematomas (CSDHs), and if the hematomas are formed, it is difficult to consider SIH as an underlying cause. Whether SIH is underlying or not among the patients presenting bilateral subdural fluid collections (hygromas or CSDHs) is clinically important because the treatment strategy should be different between them. Objectives: We designed a retrospective case-control study to figure out differential clinical features of the patients presenting bilateral symptomatic subdural fluid collections owing to SIH. Methods: Sixty-two patients with bilateral symptomatic subdural fluid collections were enrolled, and their data on general demographics, clinical courses, radiological findings, treatments, and outcomes were collected. The patients were divided into “SIH” and “Non-SIH” groups, and a simple logistic regression analysis was performed to clarify the differences between the groups. The consequent receiver operating characteristics (ROC) curve analyses were performed with the significant predictors. Results: Eight patients (13%) were diagnosed with SIH. Young age (odds ratio [OR] = 0.831, 95% confidence interval [CI]: 0.743-0.929, P =.0012), no underlying disease (OR = 0.062, 95% CI: 0.007-0.544, P =.0121), radiological features of brain sagging (OR = 10.36, 95% CI: 0.912-93.411, P =.0017), pseudo-subarachnoid hemorrhage (OR = 15.6, 95% CI: 2.088-116.52, P =.0074), and small amount of fluid collections (OR = 0.719, 95% CI: 0.579-0.893, P =.0029) were significantly associated with SIH group. ROC curve analyses were performed in parameters of age and amount of fluid collection and the cut-off values for each parameter were ≤55 years old and ≤22.08 mm, respectively. Patients diagnosed with SIH underwent epidural blood patches and showed good results, except 1 patient who underwent burr-hole trephinations. Conclusion: Bilateral subdural fluid collections due to underlying SIH is associated with young age (≤55 years old), no underlying diseases, smaller amount of fluid collections (≤22.08 mm of depth), and radiological findings of brain sagging or pseudo-subarachnoid hemorrhages.
AB - Background: Subdural hygromas are often found bilaterally in spontaneous intracranial hypotension (SIH). They frequently progress to chronic subdural hematomas (CSDHs), and if the hematomas are formed, it is difficult to consider SIH as an underlying cause. Whether SIH is underlying or not among the patients presenting bilateral subdural fluid collections (hygromas or CSDHs) is clinically important because the treatment strategy should be different between them. Objectives: We designed a retrospective case-control study to figure out differential clinical features of the patients presenting bilateral symptomatic subdural fluid collections owing to SIH. Methods: Sixty-two patients with bilateral symptomatic subdural fluid collections were enrolled, and their data on general demographics, clinical courses, radiological findings, treatments, and outcomes were collected. The patients were divided into “SIH” and “Non-SIH” groups, and a simple logistic regression analysis was performed to clarify the differences between the groups. The consequent receiver operating characteristics (ROC) curve analyses were performed with the significant predictors. Results: Eight patients (13%) were diagnosed with SIH. Young age (odds ratio [OR] = 0.831, 95% confidence interval [CI]: 0.743-0.929, P =.0012), no underlying disease (OR = 0.062, 95% CI: 0.007-0.544, P =.0121), radiological features of brain sagging (OR = 10.36, 95% CI: 0.912-93.411, P =.0017), pseudo-subarachnoid hemorrhage (OR = 15.6, 95% CI: 2.088-116.52, P =.0074), and small amount of fluid collections (OR = 0.719, 95% CI: 0.579-0.893, P =.0029) were significantly associated with SIH group. ROC curve analyses were performed in parameters of age and amount of fluid collection and the cut-off values for each parameter were ≤55 years old and ≤22.08 mm, respectively. Patients diagnosed with SIH underwent epidural blood patches and showed good results, except 1 patient who underwent burr-hole trephinations. Conclusion: Bilateral subdural fluid collections due to underlying SIH is associated with young age (≤55 years old), no underlying diseases, smaller amount of fluid collections (≤22.08 mm of depth), and radiological findings of brain sagging or pseudo-subarachnoid hemorrhages.
KW - bilateral chronic subdural hematomas
KW - bilateral subdural hygromas
KW - chronic subdural hematoma
KW - spontaneous intracranial hypotension
UR - http://www.scopus.com/inward/record.url?scp=85064546120&partnerID=8YFLogxK
U2 - 10.1111/head.13525
DO - 10.1111/head.13525
M3 - Article
C2 - 30985923
AN - SCOPUS:85064546120
SN - 0017-8748
VL - 59
SP - 775
EP - 786
JO - Headache
JF - Headache
IS - 5
ER -