A case of cerebrospinal fluid leakage complicated by impending cerebral hernia in which CT findings of the head were useful in determining the course of treatment

Abstract

The case is a 56-year-old man. The patient had headache symptoms and underwent bilateral perforation hematoma removal with a diagnosis of chronic subdural hematoma, but his symptoms did not improve and he was referred to our hospital because cerebrospinal fluid leak was suspected. Immediately prior to transfer to our hospital, a sudden loss of consciousness due to herniation of the cerebellar tonsils was observed. We urgently performed the epidural autologous blood patch (EBP), and the patient's conscious state improved immediately after the patch. Five days after EBP, he again showed consciousness impairment due to central tentorotid hernia and underwent perforator hematoma removal, which improved his consciousness. About the therapy of consciousness disturbance by the cerebrospinal fluid leak with subdural hematoma, whether to prioritize the EBP or removing hematoma operation is discussed. In the present case, the treatment strategy was determined by head CT, resulting in improvement of impaired consciousness and headache.