Bilateral subdural effusion and cerebral displacement associated with spontaneous intracranial hypotension: diagnostic and management strategies. Report of two cases.

The authors describe two patients with bilateral subdural effusion and cerebral displacement associated with spontaneous intracranial hypotension (SIH) and discuss the possible pathophysiological origins of these abnormalities. The signs seen on magnetic resonance imaging in both cases, such as tonsillar descent, subdural effusion, meningeal enhancement, downward displacement of the optic chiasm, and crowding of this structure and the hypothalamus between the pituitary gland and brain, can help to establish the diagnosis of SIH. Therapy with a lumbar epidural blood patch resulted in the rapid resolution of all symptoms and most morphological abnormalities. The authors propose diagnostic and management strategies based on their own experiences and the reported cases of SIH in the medical literature.