Surgical Resolution of Severe Headache and Ataxia Caused by Spontaneous Spinal Cerebrospinal Fluid Leak Secondary to Cerebrospinal Fluid Venous Fistula—Case Report
- Resource Type
- Original Paper
- Authors
- Timoney, Richard; Bethanabatla, Ramakrishna; Reddy, Michael; Taha, Ahmad
- Source
- SN Comprehensive Clinical Medicine. 5(1)
- Subject
- CSF venous fistula
Spontaneous spinal cerebrospinal fluid leak
Case report
- Language
- English
- ISSN
- 2523-8973
CSF venous fistulas (CVF) are a rare and only recently recognised cause of spontaneous spinal cerebrospinal fluid leak (SSCSFL). CVF are notoriously difficult to diagnose yet have been shown to have good surgical outcomes. The case reported highlights the presentation of the first documented case in New Zealand and outlines some of the challenges in diagnosis. A 63-year-old man presented with a long history of headaches, subsequently developing progressive ataxia and cognitive impairment. The patient was initially found to have features of intracranial hypotension on MRI head, though no cause could be elucidated. Multiple neuroimaging techniques were arranged over many years; no evidence of spinal CSF leak could be found. The patient was treated with 3 separate epidural blood patches, each only providing temporary relief. Ultimately a CT myelogram provided evidence of a CVF which was managed surgically with good clinical outcome. The case reported exemplifies the difficulties in reaching a diagnosis of CVF and the paucity underlying of research. Diagnostic clues in myelography such as the renal excretion of contrast and the hyperdense paraspinal vein are demonstrated—giving merit to further research.