Spontaneous CSF Collection in the Cervical Spine may Cause Neurological Deficit and Intra-cranial Hypotension

Abstract

Objective: a case is described of a spontaneously occurring cerebrospinal fluid collection in the ventral cervical spine which caused radiculopathy and spontaneous intracranial hypotension.

Case: a sixty eight year old Caucasian man presented with a 2 year history of proximal upper limb weakness with a his-tory of trivial cervical trauma many years previously.

Methods: the patient was investigated with blood tests for causes of peripheral neuropathy, nerve conduction and electro-myography studies, lumbar puncture and MRI of the brain and spine with contrast.

Results: a cerebrospinal fluid collection was identified in the ventral cervical spinal cord causing mass effect associated with cord atrophy and there were signs of spontaneous intracranial hypotension on the MRI brain including subdural cere-brospinal fluid collections, meningeal enhancement and slumped posterior fossa.

Conclusions: this is the first description of a spontaneous spinal fluid collection causing direct compression and cord sig-nal change, manifest as a motor deficit, with intracranial signs of spontaneous hypotension. Spinal imaging is recom-mended in cases of spontaneous intracranial hypotension and cerebrospinal fluid collections in the spine may rarely be a cause of radiculopathy in such cases.

Keywords: Cerebrospinal fluid; radiculopathy; spontaneous intracranial hypotension..

Fig. (1)

A. Axial T1 weighted MRI brain with gadolinium showing strong enhancement of the meninges. B. Sagital T2 weighted MRI of the craniocervical junction showing crowded posterior fossa with steeply sloping tentorium, cord atrophy from approximately C2 to C5 level with intrinsic signal change and a fluid collection likely to be a subdural CSF collection, anterior to the cord from C2 to C5.