PT  - JOURNAL ARTICLE
AU  - Mickaela Roy
AU  - Stephane Welschbillig
AU  - Marie Cantier
AU  - Dorian Chauvet
AU  - Pierre Bourdillon
AU  - Nicolas Engrand
TI  - Rescue Epidural Saline Patch for Comatose Patients With Refractory Convexity Spontaneous Subacute Subdural Hematoma
AID  - 10.1212/CPJ.0000000000200137
DP  - 2023 Apr 01
TA  - Neurology: Clinical Practice
PG  - e200137
VI  - 13
IP  - 2
4099  - http://cp.neurology.org/content/13/2/e200137.short
4100  - http://cp.neurology.org/content/13/2/e200137.full
AB  - Objectives Convexity spontaneous subacute subdural hematoma (CSSSH) frequently relapse after one or more surgical drainages. This may be due to spontaneous intracranial hypotension (SIH), for which the gold standard treatment is the epidural blood patch. In this study, we report 4 cases of refractory CSSSH treated with rescue epidural saline patch, although history and imaging studies showed no evidence of SIH.Methods All 4 patients received a lumbar saline epidural rescue patch for consciousness impairment associated with refractory CSSSH, and one is particularly detailed. No patient had typical radiologic signs of SIH or, on the contrary, uncal herniation that could have indicated intracranial hypertension.Results The Glasgow Coma Scale score improved significantly in the days after application of the epidural patch in 3 patients. All patients showed an improvement of the CT scan. Two patients underwent lumbar pressure measurement to confirm low values before the epidural injection, and for one, the intrathecal pressure profile during epidural patching is presented.Discussion An epidural patch may be considered in managing CSSSH with no uncal herniation, even in the absence of signs of SIH on brain and spinal imaging. Whether it should be combined with surgical evacuation or used as first-line therapy remains to be determined.