The role of corticosteroids in the management of CSDH is not well defined. Current evidence neither supports nor refutes the use of corticosteroids. A randomized controlled trial is warranted.

Pulse methylprednisolone therapy may reduce the risk of developing NAbs (but possibly not high-titer NAbs of clinical importance) when coadministered with newly initiated IFNB therapy. However, current evidence suggests that methylprednisolone therapy does not restore IFNB biologic response in established NAB-positive MS patients.

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Signs and symptoms of ANS impairment can occur in patients with AxD, and can include orthostatic hypotension and bowel/bladder dysfunction. Autonomic testing in our patient suggests impairment in central autonomic pathways.

A 55-year-old man who was in his usual state of good health jogged a short distance to his car as he was leaving a restaurant. As he sat down in the driver's seat, he experienced the sudden onset of a severe left occipital headache that was at maximal severity at onset and was associated with nausea and an episode of emesis. He experienced no photophobia, phonophobia, neck stiffness, or focal neurologic symptoms or signs. He had no history of headache. He presented to the emergency department at an outside institution about 20 minutes after onset. Findings on neurologic examination were normal, and he was not hypertensive.