Objective To investigate the pathogenesis,clinical manifestations,imaging features and treatment strategies of subdural hematoma in patients with spontaneous intracranial hypotension(SIH).Methods The clinical data of 5 patients with intracranial hypotension syndrome complicated by subdural hematoma admitted to the First Affiliated Hospital of Fujian Medical University from January 2018 to December 2021 were analyzed retrospectively.The clinical manifestations,imaging features and treatment strategies were summarized,and the related literature were reviewed.Results 4 patients had typical orthostatic headache.2 patients showed pseudosubarachnoid hemorrhage on head computer tomography(CT).4 patients showed diffuse dural enhancement on brain magnetic resonance imaging(MRI)scan.Headache disappeared after conservative treatment such as bed rest,intravenous and oral rehydration in 4 patients.1 patient underwent left burr hole drainage operation and the intraoperative intracranial pressure(ICP)was 1 mmHg.The hematoma pressure was low,and postoperative drainage was poor.However,strict adherence to a conservative treatment plan for low ICP syndrome after surgery resulted in a good prognosis for the patient.Conclusions The typical clinical manifestations of intracranial hypotension syndrome complicated with subdural hematoma are orthostatic headache.Subdural hematomas are mostly bilateral,and the imaging features are mainly diffuse dural enhancement on enhanced brain MRI scan.The treatment strategy is based on individualized selection of conservative treatment,epidural blood patch and extra-dural drainage according to the patient's condition.
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