Seizure following epidural blood patch in spontaneous intracranial hypotension complicated by subdural hematoma: Illustrated case and literature review

Background: Spontaneous intracranial hypotension (SIH), characterized by abnormally low intracranial pressure (ICP), is complicated by chronic subdural hematoma (SDH) in approximately 20‒25% of cases. However, the optimal treatment sequence for SIH accompanied by chronic SDH remains debated. Case Description: A 39-year-old woman diagnosed with SIH and SDH, despite the absence of significant neurological deficits or marked midline shift, experienced a 1-min generalized tonic-clonic seizure following a nontargeted L2/3 epidural blood patch (EBP). Her symptoms promptly improved after bilateral burr-hole trephination performed during the same session. Conclusion: Blood injected during EBP displaced spinal cerebrospinal fluid cranially, acutely increasing ICP in a brain with poor compliance and triggering the seizure. Our review indicates that even mild signs of raised ICP – not just coma, pupillary changes, or a Glasgow Coma Scale score <8 – can lead to serious complications post-EBP. Careful clinical and radiological assessment of ICP is essential. When intracranial hypertension is suspected, surgical decompression should precede EBP.