2021 Volume 30 Issue 1 Pages 52-57
It is generally considered that cerebrospinal fluid leakage is caused by a damaged dura mater that allows its leakage directly into the epidural space. I report a case in which cerebrospinal fluid was thought to have exuded after its infiltration into the sacral nerve root sheath and stagnant retention therein. A 19-year-old woman complained of orthostatic headache and associated symptoms for 7 years. Spinal magnetic resonance (MR) imaging/MR myelography revealed a rope-like water signal lesion with irregular margins without gadolinium enhancement, extending near the bottom of the subarachnoid space and located at the right fourth sacral nerve root sleeve. She was diagnosed as having a probable cerebrospinal fluid leakage in accordance with the diagnostic imaging criteria for cerebrospinal fluid leakage developed by the Cerebrospinal Fluid Hypovolemia Research Group. After the injection of two epidural blood patches, her orthostatic headache was resolved, associated symptoms were diminished, and MR myelography confirmed the disappearance of the lesion. Cerebrospinal fluid infiltration into the spinal nerve root sheath, stagnant retention therein, and exudation from the sheath may have occurred.
