Abstract

Headaches are one of the most frequent and nonspecific complaints of patients. A proper history and physical exam are crucial in properly diagnosing and treating a patient’s headache. One rare cause of headaches is a cerebrospinal fluid (CSF) leak which is a phenomenon in which the cerebrospinal fluid surrounding the brain and spinal cord leaks out of the protective dural sac. This can be caused in response to trauma, but often occurs in the absence of any identifiable explanation. This is known as a spontaneous CSF leak and has an incidence of 5 per 100,000 per year making it easy to overlook in a patient presenting with headache. However, it is imperative to properly diagnose and treat patients with spontaneous CSF leak to ensure the best prognosis making it an important cause of headaches for medical providers to be aware of. Here we present a novel case of a 68-year-old African American female who was seen for a headache and was subsequently found to have a spontaneous CSF leak and was treated with an epidural blood patch. We also review the neuroimaging modalities used to localize and treat CSF leaks.

Keywords: CSF leak, headache, MRI, CT myelogram

Abbreviations: CSF: Cerebrospinal fluid; MRI: Magnetic Resonance Imaging; CT: Computed tomography