부산대학교 도서관

A 71-year-old male was sent to the emergency department of our hospital in the morning of September 28, 2021 because of severe left ear pain for ten days. The emergency physician consulted the on-duty otolaryngologist and diagnosed acute otitis media, and the patient was discharged after prescription of antibiotics. In the afternoon of the same day, he visited a family physician for second opinion and was given antiviral drugs and painkillers for suspected herpes zoster infection. After about 1 week, the symptoms still persisted with accompanied headache, dizziness and unsteady gait. The patient returned to our family medicine outpatient clinic on October 4, 2021 and was admitted for further examination. During hospitalization, brain MRI showed bilateral semilunar subdural hemorrhage; after consultation with a neurosurgeon, MR myelography was arranged for suspected spontaneous intracranial hypotension, which showed cerebrospinal fluid leakage of T9/10 to L1/2. With epidural blood patch (EBP) and subdural blood drainage (burr hole drainage), the symptoms improved significantly. Older patients are often unable to address their discomfort accurately. In the face of elderly patients, in addition to detailed medical history inquiry, a comprehensive physical and neurological examination is required to avoid delays in diagnosis. Although spontaneous intracranial hypotension is generally considered non-life threatening, an epidural blood patch, or even surgery, must be arranged as early as possible. Physicians should be on the lookout for potentially fatal symptoms in clinical clues in order to give patients the right treatment.