The Journal of Headache and Pain

Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"

The Journal of Headache and Pain Cover Image

Volume 15 Supplement 1

Abstracts from the 4th European Headache and Migraine Trust International Congress: EHMTIC 2014

Open Access

EHMTI-0386. Chronic subdural hematoma and spinal cerebrospinal fluid leak and in non-geriatric patients

  • J Beck1,
  • CT Ulrich1,
  • J Gralla2,
  • J Fichtner1,
  • C Fung1,
  • W Z'Graggen2 and
  • A Raabe1
The Journal of Headache and Pain201415(Suppl 1):J16

Published: 18 September 2014


Spinal AxisCerebrospinal Fluid LeakSpinal PathologyChronic Subdural HematomaSacral Region


The etiology of chronic subdural hematoma (cSDH) in non-geriatric patients (≤60 years) often remains unclear.


The primary objective of this study was to identify spinal cerebrospinal fluid (CSF) leaks in non-geriatric patients with the hypothesis that spinal CSF leaks are causally related to cSDH.


All consecutive patients ≤ 60 years who were operated upon for cSDH from Sept. 2009 to April 2011 were included in this prospective cohort study. The patient workup included an extended search for a spinal CSF leak using a systematic algorithm: magnetic resonance (MR) imaging of the spinal axis with or without intrathecal contrast application, myelography/fluoroscopy, and postmyelography CT scanning. Spinal pathologies were classified according to direct proof of CSF outflow from intra- to extrathecal space, presence of extrathecal fluid accumulation, presence of spinal meningeal cysts, or no pathological findings.


Twenty-seven patients (mean age±SD: 49.6±9.2 years) were operated upon for cSDH. The chief complaint was headache in 15 (56%) patients. Hematomas were unilateral in 20 and bilateral in seven. In seven of 27 patients (25.9%) spinal CSF leakage was proven, in nine (33.3%) patients spinal meningeal cysts in the cervico-thoracic region were found, and three (11.1%) had spinal cysts in the sacral region. The remaining eight (29.6%) patients showed no pathological findings.


Spinal imaging results are challenging the pathogenetic concept of cSDH in young patients. The direct proof of spinal CSF leakage in 25.9% of patients suggests that spinal CSF leaks may be a frequent cause of non-geriatric cSDH.

No conflict of interest.

Authors’ Affiliations

Neurosurgery, Inselspital, Bern, Switzerland
Neuroradiology, Inselspital, Bern, Switzerland


© Beck et al; licensee Springer. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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