Recurrent Subdural Hematoma: A Case Report of Diagnostic Pitfall of Spontaneous Intracranial Hypotension and Successful Management With Targeted Epidural Blood Patch

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In a case report Lili Chen *et al.* from the Neurology Dept, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou Guangyu Ying *et al.*, Yucong Peng *et al.*; Neurosurgery Dept, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou published in the Clinical Case Reports Journal to highlight spontaneous intracranial hypotension (SIH) as a diagnostic pitfall in recurrent subdural hematoma (SDH) and to demonstrate the efficacy of targeted epidural blood patch (EBP) prior to surgical drainage. In non‑elderly patients with SDH and no trauma or obvious risk factors, SIH should be suspected. A targeted EBP may resolve the CSF leak and prevent recurrence, possibly avoiding or supplementing surgical intervention 1).

The case underscores an underrecognized etiology (SIH) in SDH, offering a valuable shift in differential diagnosis.

– Novelty: It adds to limited case literature by emphasizing targeted EBP efficacy specifically in recurrent SDH associated with SIH.

– Limitations:

– Limitations:

1. As a single case, generalizability is restricted.  

2. Details on imaging (e.g., leak localization via CT myelography) and follow‑up duration are sparse.  

3. No comparison with conservative management or surgical-only outcomes.

– Methodological rigor:

Standard diagnostic and therapeutic steps were applied, but the narrative lacks clarity on decision‑making timeline and objective measures of improvement.

– Interpretation:

The authors convincingly argue for EBP before surgery, though this remains hypothesis‑forming given the lack of broader data.

Verdict

Score: 6.5 / 10

Good clinical insight with moderate impact, yet limited by its single-case design and lack of comprehensive imaging/follow-up details.

Takeaway for Practicing Neurosurgeons

Evaluate SIH in recurrent SDH patients without trauma—employ CT myelography to localize leaks and consider targeted EBP early. This may reduce recurrence and the need for multiple surgical evacuations.

Bottom Line

In select cases of spontaneous recurrent SDH, targeted EBP can be an effective, minimally invasive first-line treatment. Further studies are needed to confirm broader efficacy.

Chen L, Ying G, Peng Y. Recurrent Subdural Hematoma: A Case Report of Diagnostic Pitfall of Spontaneous Intracranial Hypotension and Successful Management With Targeted Epidural Blood Patch. Clin Case Rep. 2025 Jul 14;13(7):e70619. doi: 10.1002/ccr3.70619. PMID: 40667497; PMCID: PMC12259495.

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