Abstract
In spontaneous cerebrospinal fluid hypovolemia (SCH), the conservative treatment is resting the patient in bed followed by intravenous hydration for several weeks. However, in cases where improvements are not established, epidural self-blood patch (EBP) therapy is then resorted. We experienced a case of SCH, who suffered symptomatic relapse five days after initial treatment with EBP therapy. The condition of the patient eventually exacerbated to coma, resulting in chronic subdural hematoma (CSH). As the coma was well managed by a conservative therapy, the condition of the patient improved when we repeated the EBP therapy followed by burr-hole irrigation for CSH two weeks later. As a sudden change in the intracranial pressure could induce acute aggravation of CSH and impairment of consciousness with acute recurrence of cerebrospinal fluid leakage, SCH patients treated by EPB therapy have to be monitored consistently. Due attention must be paid to CSH induced by spinal tap during diagnosis and possible acute recurrence after the first successful EBP therapy.
