診断に長期を要した小児脳脊髄液減少症の2例

抄録

Herein, we report two cases of cerebrospinal fluid leakage in children that we encountered at our hospital. Both presented with hearing loss.

Case 1 also suffered from blurred vision and photophobia. He exhibited a series of problem behaviors at school and violent behavior at home. These behaviors had become pronounced after a traffic accident. Ophthalmological testing using an autorefractor revealed the presence of hypertonia of the ciliary muscle and unstable refraction in both eyes. After 4 sessions of treatment with an epidural autologous blood patch (BP), the symptoms improved. The findings in this case suggest that hypertonia of the ciliary muscle and unstable refraction causing visual impairment can occur in cases of cerebrospinal fluid leakage. His abnormal behavior was the result of the abnormalities of the eyes and ears.

Case 2 had chronic dizziness in addition to the hearing loss. The dizziness and abnormalities in the stabilometer test improved a long time after BP treatment. However, the hearing impairment never complately improved.

The interval from the traffic accident to the correct diagnosis was 3 years 9 months in Case 1, and from the initial examination to the correct diagnosis was 3 years 10 months in Case 2. Patients often consult the ENT clinic due to such symptoms as headache, dizziness, hearing loss, tinnitus, and/or visual impairment. We should always bear in mind the possibility of cerebrospinal fluid leakage in such cases. Especially, children with this condition may not be able to precisely express their mental and physical distress, and may exhibit problem behaviors or strange behaviors. Therefore, it is important to obtain a careful history.