Post-traumatic hypoliquorrhea syndrome

A case of traumatic low pressure headache syndrome after a fall on the buttocks is described. This rare syndrome is probably caused by unusual cerebrospinal fluid leakage. The headaches are characterized by accentuation in the erect position and relieved by recumbency, and may be associated with nausea, vomiting, dizziness, photophobia and vertigo. Carefully executed lumbar puncture in the lateral recumbent position shows absent CSF pressure and even spontaneous aspiration of air through the lumbar puncture needle. Intracranial air resulting from puncture may be demonstrated on routine roentgenogram. In computed tomography the syndrome is associated with extremely small ventricles and tight basal cisterns. Management consists in bedrest and fluid substitution.