Misdiagnosed spontaneous intracranial hypotension complicated by subdural hematoma following lumbar puncture
A 34-year-old man without any headache history, cardiovascular risk factor, fever, or antecedent trauma had since September 3, 2010 acute postural headache that occurred within 15 minutes of assuming an upright position; it began as a pain over the vertex, and rapidly became holocephalic, with photophobia, nausea, and vomiting. The headache resolved within 10 minutes of assuming the supine position. The patient did not have aura, visual change, or other neurological symptoms. Clinical examination was normal, and did not found any hyperflexibility of skin or joints. The first cerebral computed tomography scan was normal. A brain MRI with angio-sequences did not show cerebral thrombophlebitis, and was interpreted as normal (). Lumbar puncture was performed, without a measure of cerebrospinal fluid (CSF) pressure, showed hyperproteinorachy at 2 g/L, and six cells with lymphocytosis. The headache became very intense. At admission, clinical examination was normal. Ophthalmological examination did not show any abnormalities. A second brain MRI showed bilateral subdural hematoma with tonsillar descent, simulating Chiari type I malformation (). The patient was treated by surgical drainage of the subdural hematoma and bed rest. The blood patch was not realized. The headache was completely resolved 2 days after surgery. There was no recurrence after 3 years of follow-up.