{
  "abstract": "Background Spontaneous intracranial hypotension (SIH) secondary to cerebrospinal fluid-venous fistula (CSF-VF) is increasingly recognized as a cause of atraumatic subdural hematoma (SDH). Although fistula embolization addresses the underlying CSF leak, delayed or progressive SDH enlargement after successful closure is uncommon and poorly described.Case Description A 62-year-old woman presented with acute orthostatic headache and was found to have a right convexity SDH with midline shift. Brain MRI demonstrated diffuse pachymeningeal enhancement consistent with SIH. Dynamic lateral decubitus CT myelography identified a right L2-L3 CSF-venous fistula without extradural CSF collection. The fistula was treated with CT-guided percutaneous fibrin glue embolization via the perineural root sleeve, resulting in immediate symptomatic improvement. Four days later, the patient re-presented with neurological decline and imaging demonstrated interval enlargement of the SDH with increased mass effect. Repeat CT myelography confirmed successful fistula occlusion with no residual leak. She subsequently underwent burr hole evacuation with clinical and radiographic improvement.Discussion This case highlights that subdural hematomas may continue to enlarge despite definitive CSF-VF closure. Potential mechanisms include delayed intracranial pressure normalization and membrane-driven neoangiogenesis. Early consideration of adjunctive middle meningeal artery embolization may reduce recurrence risk in select patients with SIH-associated SDH.Conclusion Progressive SDH following successful CSF-VF embolization is rare but clinically significant. Close post-procedural surveillance and multidisciplinary management are essential, and combined leak occlusion with adjunctive MMA embolization may warrant consideration in high-risk cases.Disclosures A. Baryah: None. H. Nasser: None. C. Melinosky: None.Abstract E-051 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Lehigh Valley Health Network, Allentown, PA"
      ],
      "name": "A Baryah"
    },
    {
      "affiliations": [
        "Lehigh Valley Health Network, Allentown, PA"
      ],
      "name": "H Nasser"
    },
    {
      "affiliations": [
        "Lehigh Valley Health Network, Allentown, PA"
      ],
      "name": "C Melinosky"
    }
  ],
  "title": "E-051 Progressive atraumatic subdural hematoma secondary to spontaneous intracranial hypotension from an L2 to L3 CSF venous fistula treated with CT Guided fibrin glue embolization",
  "uid": "b9eadaaf-a670-56e9-b13f-b4918c479482"
}