ORIGINAL RESEARCH article
Front. Neurosci.
Sec. Translational Neuroscience
This article is part of the Research TopicResearch on the Correlative Mechanisms and Clinical Exploration of Headache and Cerebrovascular DiseasesView all 9 articles
Intracranial hypotension headache complicated by retroclival subdural hematoma: clinical insights and literature review
Provisionally accepted
- 1Zhejiang University School of Medicine Sir Run Run Shaw Hospital Department of Neurology, Hangzhou, China, Hangzhou, China
- 2Zhejiang University School of Medicine Sir Run Run Shaw Hospital Department of Radiology, Hangzhou, China
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Background: Retroclival subdural hematoma (rcSDH) secondary to spontaneous intracranial hypotension (SIH) is an exceedingly rare clinical entity, characterized by complex and incompletely understood pathophysiological mechanisms. Case: A 24-year-old female presented with acute and persistent orthostatic headache, with no history of trauma or anticoagulant therapy. Neuroimaging revealed subdural hematomas (SDH) located in the retroclival, infratentorial, and right frontal regions, without overt evidence of brain sagging. It was hypothesized that veinous rupture, resulting from venous traction due to decreased cerebrospinal fluid (CSF) pressure, was the underlying mechanism. Following epidural blood patch (EBP) therapy, the patient exhibited marked symptomatic improvement and radiological resolution of hematomas on follow-up imaging. Conclusion: RcSDH is considered an uncommon complication of SIH, potentially resulting from venous rupture in the retroclival subdural space due to reduced CSF pressure. SIH should be considered in cases of rcSDH. The treatment is typically focused on addressing the underlying etiology, with early diagnosis and timely intervention being essential for achieving favorable outcomes. In cases of severe brainstem compression, hematoma evacuation should be performed in conjunction with EBP.
Keywords: epidural blood patch (EBP), orthostatic headache, retroclival subdural hematoma (rcSDH), Spontaneous intracranial hypotension (SIH), Venous rupture
Received: 25 Nov 2025; Accepted: 03 Dec 2025.
Copyright: © 2025 Yang, Zhang, Zhang, Hu, Wang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jin Wang
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