A Subdural hematoma (SDH) is a complication of spontaneous intracranial hypotension (SIH). However, the clinical course of SDH in SIH patients has not been fully understood. Although several cases have been reported in the literature, treatment options have limitedevidences. An epidural blood patch (EBP) is generally considered for sealing cerebrospinal fluid leaks, but rarely, progressive SDH in SIH may happen in spite of the EBP. Here, we describe a case of progressive SDH in SIH. A 35-year-old male presented with a history anddiagnostic imaging findings consistent with SDH in SIH. The intractable postural headache was relieved after a first EBP at the C7-T1 level. Three days later, the headache recurred and SDH increased, so bilateral burr hole surgery was performed. On postoperative day 1,a second EBP was done at the same level, resulting in a complete and lasting resolution of the headache. This case suggests the viability of EBP and the need of surgical treatment for SDH in SIH. Understanding the clinical presentation and characteristics of SIH should helpwith safe and effective management.

Keywordsepidural blood patch, headache, spontaneous intracranial hypotension, subdural hematoma.