Objective: To assess the differences between spontaneous intracranial hypotension and chronic subdural hematoma on clinical and imaging characteristics. Methods: We retrospectively analyzed clinical and imaging data of 20 patients with SIH and 20 patients with chronic subdural hematoma. Results: Both of SIH and chronic subdural hematoma (CSH) were characterized by headache, SIH was characterized by postural headache, 5 patients has subdural hematoma, with symptoms such as vertigo, nausea, vomit, posterior neck pain, tinnitus, hearing loss, all patients had low cerebrospinal fluid (CSF) pressure (<60 mmH2O). Except headache, some patients with CSH had mental disorders and hemiplegia symptoms. Imaging on the two groups of the performance of the subdural T1 equal signal, T2 high signal performance, SIH had diffuse pachymeningeal gadolinium enhancement, brain tissue swelling, some had brain sagging, and CSH does not have these characteristics. The conservative treatment effect of SIH is good, but the conservative treatment of subdural hematoma is poor, and it needs to be bored. Conclusion: There are similarities between SIH and subdural hematoma in clinical and imaging features, attention should be paid to differentiate SIH and CSH, therefore physician provide the most appropriate treatment to these patients.