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Our primary objectives were to identify spinal CSF leaks and spinal meningeal cysts in our cohort with the hypothesis that spinal CSF leaks are causally related to CSDH. Triggered by our experience with a young man with recurrent CSDH whose recurrence only stopped after a spinal CSF leak was sealed, we started to include the search for spinal CSF leakage into a prospective protocol for all consecutive nongeriatric CSDH patients. In younger patients, brain atrophy is generally not so prominent and a history of head trauma is often not present.
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A history of mild head trauma in many older patients is suggestive of trauma as a causative agent. 5, 10 In older patients, mechanical forces related to brain atrophy enable formation and growth of CSDH. 5, 14, 28, 29 Further and chronic enlargement of the subdural hematoma is believed to be due to microbleedings from fragile walls of sprouting vessels, accumulation of fluid in this newly created space following an osmotic gradient created by blood degradation products, or a combination of these events. The most commonly accepted pathophysiological explanation of CSDH is that mild head trauma leads to tearing of bridging veins with subsequent bleeding between the inner layer of the dura mater and the arachnoid, or between the outer and inner layers of the dura, thus creating the hematoma. C hronic subdural hematomas (CSDHs) are generally regarded to be consequences of head trauma.