Intracranial Acute Subdural Hematoma Induced by Increased Intraperitoneal Pressure: Two Case Reports

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Anon-traumatic intracranial acute subdural hematoma (ASDH) may be caused by vascular malformations such as cerebral aneurysms, cerebral arteriovenous malformations, a dural arteriovenous fistula, brain tumor, and blood coagulation/fibrinolysis abnormalities. We treated two patients with an intracranial ASDH without these factors or a direct head injury, and we speculated that the ASDHs were induced by increased intraperitoneal pressure.

SpinalASDH due to increased pressure of spinal veins was reported to occur when the intrathoracic pressure rises accompanied by an elevation of intraperitoneal pressure. The pressure of intracranial veins, which do not have a valve structure, is not easily increased because of the internal jugular vein valve, even if the central venous pressure rise when the intrathoracic pressure elevates. However, internal jugular vein. valvular insufficiency, which results in an elevation of the intracranial venous pressure accompanied by central venous pressure elevation due to the increase in the intrathoracic and intraperitoneal pressure, has been identified in 25%–45% of healthy individuals. We report two cases of intracranial ASDH which were presumed to be triggered by an elevation of intraperitoneal pressure.