Bilateral subdural hematomas and hearing disturbances caused by spontaneous intracranial hypotension.

Spontaneous Intracranial Hypotension (SIH) is an uncommon headache syndrome. Patients classically present with orthostatic headache, tinnitus, and diplopia. The authors reported a 43 year-old man who presented with orthostatic headache, tinnitus, and hearing impairment for 3 months. Physical examination was unremarkable except for auditory impairment. The audiogram revealed minimal low-frequency neurosensori hearing loss suggesting a cochlear lesion. Computed tomography of the brain revealed bilateral thin chronic subdural hematomas. He underwent burr-hole surgery. Headache and auditory symptoms persisted and reevaluation of this syndrome was performed MRI of the brain showed diffuse smooth enhanced dura mater low lying position of midbrain, pons, medullar and cerebellar tonsil, as well as enlarged pituitary gland compatible with low CSF pressure syndrome. MRI of the whole spine could not demonstrate the site of CSF leakage. The patient was much improved after conservative treatments with hydration and bed rest. One year after treatment, he had no headache and only mild tinnitus was reported.