Abstract
Spontaneous leaks of cerebrospinal fluid (CSF) from the meningeal diverticulum or the root sleeves cause intracranial hypotension ; spontaneous cerebrospinal fluid hypovolemia (SCH). The most typical feature of SCH is an orthostatic headache which is painful in the upright position and is relieved by recumbency. Nausea caused by the irritation of the meninges is often seen and the disorders of visual and hearing functions are also observed. Diffuse dural enhancement is the essential finding in magnetic resonance imaging of SCH. Radioisotope cisternography and CT myelography are used to detect the point of the CSF leakage. An epidural blood patch is necessary for the patient who didn't recover by bed rest and fluid intake for a couple of weeks.
During a decade in Japan, the presence of “traumatic” cerebrospinal fluid hypovolemia (TCH) has been a matter of debate. Supporters of TCH have declaired that the CSF leakage from the lumbar meninges can occur from trauma such as traffic accidents and can be proved by RI cisternography. We found out that the RI collection at the lumbar spine is not a leakage of CSF but a normal root sleeve without any epidural collection of CSF by CT myelography. We claim that the presence of TCH is suspicious.
