PMC10149143_01
A, B: Initial brain CT scan shows bilateral CSDH and pseudo-SAH.
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C: Brain MRI shows diffuse pachymeningeal enhancement.
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D, E: CT myelography reveals epidural contrast retention at the C6-T2 level.
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The Glasgow Coma Scale was 7 (E1V1M5) upon arrival, and brain computed tomography (CT) scan showed bilateral CSDH (Fig. 1A-B). Brain magnetic resonance imaging (MRI) showed diffuse gadolinium pachymeningeal enhancement, and CT myelography revealed epidural contrast retention from the sixth cervical vertebra to the second thoracic vertebra (C6-T2) level, consistent with a clinical diagnosis of bilateral CSDH caused by SIH (Fig. 1C-E).
A: Postoperative CT scan shows epidural contrast retention.
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B, C: Brain CT scan 3 months after operation shows CSDH disappearance.
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D: Time course of case 1.
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ICP elevation occurred. Immediate postoperative CT scan of the spine showed contrast medium in the epidural space (Fig. 2A). No recurrence of CSDH was noted, and his headache was cured (Fig. 2B-C). Perioperative course of case 1 is described in Fig. 2D.
PMC10149143_02
A, B: Initial brain CT scan shows bilateral CSDH and pseudo-SAH.
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C: Brain MRI shows diffuse pachymeningeal enhancement.
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D, E: CT myelography reveals epidural contrast retention at the Th2-Th8 level.
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He was alert on arrival, and brain CT scan showed bilateral CSDH (Fig. 3A-B). T2-8 level (Fig. 3C-E). Thus, left hematoma drainage and ICP monitor insertion, followed by EBP under fluoroscopy with clamping of the drainage catheter, was done.
A: Postoperative CT scan shows epidural contrast retention.
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B, C: Brain CT scan 3 months after operation shows CSDH disappearance.
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D: Time course of case 2.
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Postoperative spine CT scan showed the contrast medium in the epidural space (Fig. 4A). No recurrence of CSDH was noted, and his headache was cured (Fig. 4B-C). Perioperative course of case 2 is described in Fig. 4D.