Spontaneous intracranial hypotension and bilateral subdural hematoma in the spectrum of antiphospholipid syndrome and systemic lupus erythematosus: a challenging clinical encounter

Abstract

Spontaneous intracranial hypotension (SIH) linked to the leakage of cerebrospinal fluid typically manifests as positional headaches. The connection between connective tissue disorders and SIH is widely recognized. Nevertheless, instances of SIH related to systemic lupus erythematosus are infrequently reported. We report a 42-year-old female with systemic lupus erythematosus and antiphospholipid syndrome who presented with severe orthostatic headaches. Imaging revealed bilateral subdural hematomas and diffuse pachymeningeal enhancement. Conservative treatment was administered, and the patient showed improvement with resolution of symptoms. It is important to note that not all imaging studies consistently reveal all the characteristic features of SIH. Due to these diagnostic limitations, it is crucial for clinicians to consider a combination of patient history, clinical evaluation and imaging findings meticulously.

Executive summary

Introduction

• SIH may occur in SLE patients who present with orthostatic headaches.

Case Presentation

• We reported a 42-year-old female with SLE and APS presenting with a severe orthostatic headache. The patient's medical history, current medications, and diagnostic findings, including laboratory results and imaging, are discussed.

Discussion

• There is no single definitive test to diagnose IH. It often requires a combination of clinical evaluation, imaging, and other diagnostic procedures, which can be inconclusive. Furthermore, it is important to note that not all imaging studies consistently reveal all the characteristic features of SIH.

Conclusion

• Due to these diagnostic limitations, it is crucial for healthcare providers to meticulously consider a combination of clinical evaluation, patient history, and imaging findings when suspecting SIH, especially in the context of a SLE patient presenting with headaches.

Keywords: :

• antiphospholipid syndrome
• Spontaneous intracranial hypotension
• subdural hematoma
• systemic lupus erythematosus

Author contributions

Arsh Haj Mohamad Ebrahim Ketabforoush, and Nahid Abbasi Khoshsirat involved in study concept and design. Zahra Ahmadian did acquisition of data. Arsh Haj Mohamad Ebrahim Ketabforoush, Zahra Ahmadian, Ali Hosseinpour, and Nahid Abbasi Khoshsirat drafted the manuscript. Nahid Abbasi Khoshsirat, Arsh Haj Mohamad Ebrahim Ketabforoush, Zahra Ahmadian, and Ali Hosseinpour involved in critical revision of the manuscript for important intellectual content. Nahid Abbasi Khoshsirat, Arsh Haj Mohamad Ebrahim Ketabforoush, Zahra Ahmadian, and Ali Hosseinpour involved in administrative, technical, and material support. Nahid Abbasi Khoshsirat supervised the study.

Financial disclosure

The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case report.

Acknowledgments

The authors want to thank the Clinical Research Development Unit (CRDU) of Shahid Rajaei Hospital, Alborz University of Medical Sciences, Karaj, Iran, for their support, cooperation, and assistance throughout this study.