Management of cervical CSF-venous fistula causing acute cognitive impairment and coma

Acta Neurochir (Wien). 2024 Jan 26;166(1):37. doi: 10.1007/s00701-024-05935-0.

Abstract

CSF-venous fistulas (CVFs) are increasingly recognised as a cause of spontaneous intracranial hypotension. They may present atypically including with brain sagging pseudo-dementia. Cervical CVFs are rare and their management can be difficult due to associated eloquent nerve roots. We report the case of a 49-year-old woman who presented with cognitive decline progressing to coma. Brain imaging showed features of spontaneous intracranial hypotension and a right C7 CVF was identified at digital subtraction and CT myelography. Initial treatment with CT-guided injection of fibrin sealant produced temporary improvement in symptoms before surgical treatment resulted in total clinical remission and radiological resolution.

Keywords: CSF-venous fistula; Frontotemporal dementia; Spinal CSF leak; Spontaneous intracranial hypotension.

Publication types

  • Case Reports

MeSH terms

  • Ascomycota*
  • Cerebrospinal Fluid Leak
  • Coma / etiology
  • Female
  • Fistula* / complications
  • Humans
  • Intracranial Hypotension* / complications
  • Intracranial Hypotension* / diagnostic imaging
  • Intracranial Hypotension* / therapy
  • Middle Aged
  • Myelography / methods
  • Tomography, X-Ray Computed