Intracranial hypotension following traumatic brain injury: a diagnostic and therapeutic challenge

Abstract Background Intracranial hypotension (IH) is a recognised cause of coma, however, the diagnosis is often challenging, especially in patients with superimposed traumatic brain injury (TBI). Case report We report a case of a 67-year-old patient who became comatose following evacuation of bilateral acute subdural haematomas with concurrent respiratory failure. Imaging and intraparenchymal intracranial pressure (ICP) monitoring confirmed secondary IH. She was managed with an epidural blood patch, and a 72 hours period in the trendelenberg position guided by ICP monitoring and clinical assessment. She subsequently made an excellent neurological recovery from an initial Glasgow coma scale (GCS) of 3 to a GCS of 15. Conclusion A diagnosis of secondary IH can easily be missed in patients who have suffered a primary brain injury. In patients with a poor neurological recovery, clinicians should rule out secondary IH as a potential cause as immediate treatment can lead to a profound clinical improvement.