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Cerebrospinal fluid hypotension following fall in a child: Case report

Gabriela Botelho1, Ricardo Domingos Grilo1, Vera Domingos Almeida1

  • 1Hospital do Espírito Santo de Évora, Portugal.

Neurocirugia (English Edition)
|June 20, 2022
PubMed

Insights

A ten-year-old boy experienced symptoms of cerebrospinal fluid (CSF) hypotension after a fall. An occult intrasacral meningocele and S3 fracture led to a CSF fistula, causing his condition.

Area of Science:

  • Neurology
  • Trauma Surgery
  • Pediatric Orthopedics

Background:

  • Cerebrospinal fluid (CSF) hypotension results from CSF leaks, causing negative intracranial pressure.
  • Sacral fractures, often from high-energy trauma, are commonly underdiagnosed.
  • Intrasacral meningoceles are rare congenital abnormalities that can be associated with spinal trauma.

Observation:

  • A 10-year-old boy presented with hip pain after a fall, with normal neurological examination.
  • He developed biparietal headache, nausea, and vomiting upon standing, which resolved when lying down.
  • CT revealed an occult intrasacral meningocele; MRI showed CSF along the spine and an S3 fracture.

Findings:

  • The MRI confirmed an S3 fracture with potential meningocele laceration, leading to a CSF fistula.
  • The patient's symptoms were diagnosed as CSF hypotension secondary to this fistula.
  • This case highlights the diagnostic challenge of spontaneous CSF hypotension in children.

Implications:

  • Early diagnosis and management of CSF hypotension secondary to traumatic fistulas are crucial.
  • High-energy trauma evaluation should include assessment for occult sacral fractures and meningoceles.
  • This case underscores the importance of advanced imaging in diagnosing rare pediatric spinal conditions.

Keywords:
Cefalea.Cerebrospinal fluid hypotensionDisrafismo espinal ocultoFistulaFractura de sacroFístulaHeadacheHipotensión del líquido cefalorraquídeoNeuroimagenNeuroimagingOccult spinal dysraphismSacral fracture

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