Intractable Headache and Cerebrospinal Fluid Leakage in Adolescence

Abstract

Introduction : Cerebrospinal fluid (CSF) leakage is often considered a problem in adults but also affects younger patients. In this study, we analyzed the clinical features of pediatric CSF leakage.

Material & Methods : A total of 212 patients (107 boys and 105 girls) who experienced the onset of CSF leakage before the age of 15 were investigated for causes, outcomes, and clinical features.

Results : Among the 212 patients, 61 (28.8％) were capable of limited self-care, and 55 (25.9％) were completely disabled. A total of 116 patients (54.7％) did not attend school before the epidural blood patch (EBP). After EBP, 190 (89.7％) patients recovered sufficiently to attend school. Complete recovery was achieved in 79 patients (37.3％).

Conclusions : CSF leakage is not well-recognized, particularly in children and adolescents. Some children were diagnosed with autonomic nervous system dysfunction, orthostatic dysregulation, Barré-Liéou syndrome, postural tachycardia syndrome, or depression. Despite administration of definitive therapies such as counseling, analgesics, tranquilizers, or antiepileptic drugs, these symptoms persisted chronically or progressed daily. In cases where patients experience related symptoms such as intractable headaches, CSF leakage should be considered in the differential diagnosis.