Posttraumatic cerebrospinal fluid leak with cognitive dysfunction, especially visual memory disturbance: illustrative...

Cerebrospinal fluid (CSF) leaks are associated with various clinical and neurological manifestations. Although cognitive dysfunction has been reported in patients with a CSF leak, its detailed characteristics and cognitive profile remain unclear.

A 17-year-old male patient developed progressive cognitive decline after minor head trauma. The initial neuroimaging findings were unremarkable; however, over several months, he exhibited memory impairment, academic decline, and personality changes. Neuropsychological testing has demonstrated significant deficits in visual memory, reduced working memory, and reduced processing speed. A detailed interview revealed a subtle orthostatic headache that had been present since the head injury, prompting further evaluation. Spinal MRI and CT myelography confirmed a CSF leak in the cervical spine. The patient underwent placement of a blind lumbar epidural blood patch, which resulted in immediate headache relief and gradual cognitive improvement, particularly in visual memory.

CSF leaks can manifest primarily as cognitive dysfunction, even without typical headache or imaging findings, leading to diagnostic delays and potential misdiagnosis of psychiatric illnesses. Visual memory impairment might represent a characteristic and underrecognized feature of a CSF leak. Comprehensive neuropsychological assessment with domain-specific testing is essential for accurate diagnosis of atypical presentations. https://thejns.org/doi/10.3171/CASE25939.