J Med Assoc Thai 2009; 92 (11):1538

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Bilateral Subdural Hematomas and Hearing Disturbances Caused by Spontaneous Intracranial Hypotension
Srimanee D Mail, Pasutharnchat N , Phanthumchinda K

Spontaneous Intracranial Hypotension (SIH) is an uncommon headache syndrome. Patients classically
present with orthostatic headache, tinnitus, and diplopia. The authors reported a 43 year-old man who
presented with orthostatic headache, tinnitus, and hearing impairment for 3 months. Physical examination
was unremarkable except for auditory impairment. The audiogram revealed minimal low-frequency neurosensori
hearing loss suggesting a cochlear lesion. Computed tomography of the brain revealed bilateral thin
chronic subdural hematomas. He underwent burr-hole surgery. Headache and auditory symptoms persisted
and reevaluation of this syndrome was performed. MRI of the brain showed diffuse smooth enhanced dura
mater, low lying position of midbrain, pons, medullar and cerebellar tonsil, as well as enlarged pituitary
gland compatible with low CSF pressure syndrome. MRI of the whole spine could not demonstrate the site of
CSF leakage. The patient was much improved after conservative treatments with hydration and bed rest. One
year after treatment, he had no headache and only mild tinnitus was reported.

Keywords: Spontaneous intracranial hypotension, Bilateral subdural hematomas, Tinnitus, Hearing loss,
Audiogram


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