Bilateral subdural hematomas complicating intracranial hypotension following lumbar spine procedures: two case reports

Introduction and importance: Subdural hematomas (SDHs) commonly result from trauma but can also occur due to spontaneous intracranial hypotension (SIH) linked to cerebrospinal fluid (CSF) leaks, especially following lumbar spine procedures. This study aims to explore two rare cases of bilateral SDH in patient's post-spine surgery and their connection to intracranial hypotension (IH). Case presentations: Two case reports are presented, one involving a 70-year-old male post-laminectomy and discectomy, and another a 36-year-old female post-cesarean section with spinal anesthesia. Both developed bilateral SDH associated with CSF leaks and underwent surgical intervention. Both patients showed significant improvement following emergency subdural hematoma evacuation, with complete resolution of IH symptoms and recovery of neurological function. Discussion: IH from CSF leakage leads to compensatory venous engorgement and possible subdural hematoma formation. Dural tears, commonly associated with spinal surgery or anesthesia, are frequent causes. Early diagnosis through MRI and prompt management with conservative therapy such as bed rest, hydration, caffeine, steroids, and epidural blood patch are vital. Surgical evacuation may be required in refractory or worsening cases. Individualized treatment based on clinical condition ensures optimal recovery and minimizes complications. Conclusion: This study highlights the risk of bilateral SDHs following lumbar spine procedures due to SIH. While conservative treatments may help, surgical intervention is necessary when they fail. Prompt recognition and tailored management of CSF leaks and associated SDHs are key to preventing neurological deterioration and achieving favorable outcomes.