Cerebrospinal Fluid Leak Secondary to Whiplash Injury

TL;DR

A 15-year-old girl developed a rare cerebrospinal fluid leak after a neck injury, which was successfully treated with an epidural blood patch.

Contribution

This case highlights the importance of diagnosing rare CSF leaks in young patients with atypical injuries.

Findings

A CT myelogram confirmed a CSF leak along the left T9 nerve root up to T3-T4 levels.

An epidural blood patch provided significant symptomatic relief, with an 80% improvement in pain.

Prompt diagnosis and treatment of CSF leaks can optimize patient outcomes.

Abstract

Although rare, cerebrospinal fluid (CSF) leaks can prove to be detrimental if severe. Usually secondary to dural punctures, CSF leaks can present as severe headaches, neck pain, blurry vision, confusion, and nausea. However, patients can also be asymptomatic. Due to the rarity and variability in symptom presentation, the diagnosis of these leaks is often missed. We present a case of a 15-year-old female who had been experiencing severe headaches after she hyperextended her neck during a horseback ride. On diagnostic imaging, a CT myelogram confirmed a CSF leak with contrast extravasation along the left T9 nerve root up to the T3-T4 levels. After confirmation, the patient received an epidural blood patch, with 15 ml of autologous blood injected into the epidural space. After the procedure, the patient experienced significant symptomatic relief, resulting in an 80% improvement in her pain scale. Our case demonstrates how a prompt and accurate diagnosis of a CSF leak can optimize patient outcomes.

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