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[Liquorrhea with multiple subdural hematomas causing reversible prospagnosia].

Masako Nakano¹, Fujio Umehara

¹Department of Neuology, Nanpuh Hospital.

Rinsho Shinkeigaku = Clinical Neurology

|February 23, 2012

Summary

A woman with cerebrospinal fluid (CSF) leak developed severe headaches and face blindness (prosopagnosia) due to subdural hematomas. Her symptoms improved as the hematomas resolved, suggesting a link between CSF leaks, brain bleeds, and reversible prosopagnosia.

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Area of Science:

Neurology
Neuroimaging
Neurosurgery

Background:

Headache associated with cerebrospinal fluid (CSF) leak, also known as liquorrhea, can present with various neurological symptoms.
Pachymeningeal enhancement on MRI and low CSF opening pressure are indicative of CSF leak.

Observation:

A 48-year-old woman with liquorrhea developed severe positional headaches and subsequently, acquired prosopagnosia.
Brain imaging revealed diffuse pachymeningeal enhancement, low CSF opening pressure, and a lumbar CSF leak. Later, subdural hematomas below the fusiform gyri and cerebral hypoperfusion were observed.

Findings:

The patient presented with headache, confirmed CSF leak, and developed prosopagnosia, a deficit in facial recognition.
Subdural hematomas were identified beneath the fusiform gyri, correlating with the onset of prosopagnosia.
Resolution of subdural hematomas and pachymeningeal enhancement coincided with the improvement of prosopagnosia and cerebral blood flow.

Implications:

This case highlights a potential link between liquorrhea-induced subdural hematomas and acquired, reversible prosopagnosia.
Subdural hematomas, particularly those affecting the fusiform gyrus, should be considered in cases of unexplained prosopagnosia.
Neuroimaging plays a crucial role in diagnosing CSF leaks and associated complications like subdural hematomas and their neurological sequelae.