Management of an intracranial hypotension patient with diplopia as the primary symptom: A case report

Figure 1 Axial brain image acquired before suspicion of having intracranial hypotension. A: Axial computed tomography image shows left-sided subdural effusion, right-sided subdural hematoma (orange arrows), compression of the right ventricle and midline shift on day 1; B: Axial T1-weighted magnetic resonance imaging (MRI) with gadolinium enhancement reveals diffuse pachymeningeal thickening and subdural hematomas (SDHs) on both sides on day 3 (orange arrows); C: Axial T2-weighted MRI with gadolinium enhancement reveals SDHs with high signal in the same area on day 3 (orange arrows).

Figure 2 Magnetic resonance myelography imaging of the spine performed before epidural blood patch therapy. A: Magnetic resonance myelography (MRM) shows multiple sites of cerebrospinal fluid (CSF) leakage at cervicothoracic junctions on day 9 (orange arrows); B: MRM shows multiple sites of CSF leakage in the thoracic region on day 9 (orange arrows).

Figure 3 Images of the brain and spine acquired after the epidural blood patch therapy. A: Axial computed tomography (CT) image shows bilateral subdural hematomas with greater density and volume than the previous hematomas on day 21 after the first epidural blood patch (EBP) therapy (orange arrows); B: Magnetic resonance myelography (MRM) shows multiple sites of cerebrospinal fluid (CSF) leakage at cervicothoracic junctions on day 30 after the second EBP therapy(white arrows); C: MRM shows multiple sites of CSF leakage in the thoracic region on day 30 after the second EBP therapy (white arrows); D: Sagittal CT myelography imaging of the entire spine reveals no obvious CSF leakage on day 57 after the third EBP therapy.

Figure 4 shows the medical history chronologically. CSF: Cerebrospinal fluid; CT: Computed tomography; EBP: Epidural blood patch; IH: Intracranial hypotension; MRI: Magnetic resonance imaging; MRM: Magnetic resonance myelography; SDH: Subdural hematoma.