[Case of cerebrospinal fluid hypovolemia possibly due to acceleration of cerebrospinal fluid absorption].

ABSTRACT

The authors present a case of a 31-year-old man suffering from intractable cerebrospinal fluid hypovolemia (CSFH), in whom autologous epidural blood patch at the cervical, thoracolumbal, and sacral sites was not effective. Repeated radionuclide cisternography reproducibly demonstrated "early accumulation of radioactivity in the bladder", "cystic accumulation of radioactivity at the sacral site" and "less activity than expected over the cerebral convexities"; but computerized tomography myelography did not demonstrate CSF leakage but detected a sacral cyst. These repeated radionuclide cisternography findings suggested unusually rapid uptake of tracer by the circulation but did not always CSF leakage. The finding of strong accumulation of radioactivity in the sacral cyst might mean the opposite CSF flow against normal caudal-cranial flow. The formation of this abnormal cranial-caudal CSF flow could be produced with CSF leakage or abnormal absorption at the caudal site, where the cyst existed in the patient. Therefore, it is not unreasonable to suppose that the sacral cyst appeared to be responsible for development of CSFH in the patient. The possibility of acceleration of cerebrospinal fluid absorption in the sacral cyst was proposed for the cause of CSFH if CSF leakage was denied.