Resolution of hypertension symptoms following cerebrospinal fluid leak with acetazolamide: a case report

Incidental durotomy and the subsequent cerebrospinal fluid (CSF) leak are well-recognized complications of spine surgery. While primary repair can be effective, persistent symptomatic leaks may necessitate more advanced interventions, and some patients continue to experience refractory headaches after spine surgery-related CSF leak treatment.

This case report describes two patients who presented with chronic headaches following CSF leak resolution and symptoms indicative of intracranial hypertension (ICH), including tinnitus, visual disturbances, and dizziness. Case 1 was a 46-year-old male who suffered from a continual low-grade headache that intensified when lying down, particularly disturbing him during the early hours of the morning. A myelogram revealed excessive intradural pressure. Case 2 was a 55-year-old female who required a temporary lumbar drain as part of her treatment for a persistent CSF leak; she experienced headaches that were particularly severe at night and worsened with exertion or prolonged activity.

Both patients reported tinnitus and visual changes closely aligned with headache symptoms. They were treated for ICH using a 4 weeks regimen of acetazolamide, followed by a tapering period of 4 weeks. With the initiation of acetazolamide, both patients experienced near-complete relief from their symptoms and were successfully weaned off. It is hypothesized that both individuals may have developed an overproduction of CSF following their prior leaks, leading to ICH, which effectively mitigated Acetazolamide's established role in reducing intracranial pressure.