Intracranial hypotension headache complicated by retroclival subdural hematoma: clinical insights and literature review.

Background: Retroclival subdural hematoma (rcSDH) secondary to spontaneous intracranial hypotension (SIH) is an exceedingly rare clinical entity, characterized by complex and incompletely understood pathophysiological mechanisms. Case: A 24-year-old female presented with acute and persistent orthostatic headache, with no history of trauma or anticoagulant therapy. Neuroimaging revealed subdural hematomas (SDH) located in the retroclival, infratentorial, and right frontal regions. It was hypothesized that veinous rupture, resulting from venous traction due to decreased cerebrospinal fluid (CSF) pressure, was the underlying mechanism. Following epidural blood patch (EBP) therapy, the patient exhibited marked symptomatic improvement and radiological resolution of hematomas on follow-up imaging. Conclusion: RcSDH is considered an uncommon complication of SIH, potentially resulting from venous rupture in the retroclival subdural space due to reduced CSF pressure. SIH should be considered in cases of rcSDH. The treatment is typically focused on addressing the underlying etiology, with early diagnosis and timely intervention being essential for achieving favorable outcomes. In cases of severe brainstem compression, hematoma evacuation should be performed in conjunction with EBP.