Central nervous system manifestations
Central nervous system complications from low CSF volume and pressure secondary to spinal CSF leak may or may not be directly related to the low CSF volume and pressure but are very frequently reported. These include:
- Cognitive dysfunction (concentration, memory, problem-solving, etc),
- Mood changes
- Anxiety symptoms
- Imbalance is also very common and appears to have several mechanisms.
Spinal manifestations
Spinal manifestations of spinal CSF leak occur with variable frequency. Common symptoms include:
- Pain or tightness between shoulder blades
- Arm pain or numbness (from traction on cervical nerve roots).
Less common:
- Pain, numbness, or weakness at other spinal levels from nerve root compression or traction, often from extrathecal CSF collections.
Rare:
- Neurologic deficit related to compression of the spinal cord or traction on nerve roots by fluid collections which manifests in a variety of ways, for example, upper limb weakness, quadriplegia or changes in gait
- Syringomyelia (fluid-filled cavity within spinal cord)
Severe complications
Severe complications as a result of intracranial hypotension (low CSF volume and pressure) from spinal CSF leaking are uncommon or rare but do occur. Prompt recognition and treatment of many of these are of critical importance.
- Tremor mimicking Parkinson’s disease
- Ataxia
- Cerebellar hemorrhage
- Superficial siderosis
- Subarachnoid hemorrhage
- Cerebral venous thrombosis
- Dementia (such as behavioral-variant frontotemporal pattern)
- Stupor and coma
- Stroke
- Reversible cerebral vasoconstriction (RCVS)
- Posterior reversible encephalopathy syndrome (PRES)
- Death
Further reading
For more on diagnostic challenges and central nervous system involvement in spinal CSF leak, please see the following articles: