{"id":"a30cd8ea-d747-4419-b9ed-628fa0ff12e6","slug":"when-does-too-little-pressure-become-too-much-a-case-of-spontaneous-intracranial-hypotension-presenting-with-acute-loss-of-consciousness","title":"When does too little pressure become too much? A case of spontaneous intracranial hypotension presenting with acute loss of consciousness","authors":["Conor Brosnan","Mohamed Osman Dablouk","Vincent Healy","Daniel Murray","Hamzah A. Soleiman","Ciaran Bolger"],"abstract":"Background: We present a unique case of spontaneous intracranial hypotension (SIH) presenting with acute collapse and loss of consciousness. Case Description: The affected patient suffered an abrupt decline in level of consciousness several weeks after initial diagnosis. The patient was urgently transferred to a specialist neurosurgical unit. Imaging showed bilateral subdural fluid collections with significant associated local mass effect. The treating team faced a clinical conundrum with a lack of clarity as to whether this sudden deterioration was secondary to the local pressure effect on brainstem traction from reduced intracranial pressure. A decision was made to proceed with urgent burr-hole decompression of the bilateral subdural fluid collections. Conclusion: After a protracted, complex postoperative course, the patient recovered to full functional independence. To the author’s knowledge, this is the first case in literature describing successful surgical management of SIH, with bilateral burr-hole evacuation to relieve the paradoxical mass effect of bilateral subdural fluid collections.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/a30cd8ea-d747-4419-b9ed-628fa0ff12e6/featured/hero-1781560037994.png","publishDate":"2023-09-15T00:00:00.000Z","doi":"10.25259/SNI_293_2023","categories":["General Neurosurgery","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/a30cd8ea-d747-4419-b9ed-628fa0ff12e6/pdf"}