Cerebrospinal fluid hypovolemia syndrome after a traffic accident with abnormal eye movements: A case report

• Published in: American journal of ophthalmology case reports Vol. 20; p. 100997
• Main Authors: Shinmei, Yasuhiro, Takahashi, Akihiro, Nakamura, Kayoko, Shinkai, Akihiro, Tagawa, Yoshiaki, Chin, Shinki, Ishida, Susumu
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2020; Elsevier
• Subjects: And epidural blood patch therapy; Case Report; Cerebrospinal fluid hypovolemia syndrome; Decreased pursuit gain; Oscillopsia; Reading difficulties; Square wave jerks; Oscillopsia; and square wave jerks; magnetic resonance imaging; epidural blood patch; Square wave jerks; And epidural blood patch therapy; Cerebrospinal fluid hypovolemia syndrome; cerebrospinal fluid; Reading difficulties; Decreased pursuit gain; MR myelography; Cerebrospinal fluid hypovolemia syndrome, (CHS); epidural blood patch, (EBP); cerebrospinal fluid, (CSF); MR myelography, (MRM); and square wave jerks, (SWJs); magnetic resonance imaging, (MRI)
• ISSN: 2451-9936; 2451-9936
• DOI: 10.1016/j.ajoc.2020.100997

To describe a rare case of cerebrospinal fluid hypovolemia syndrome after a traffic accident with abnormal eye movements.
A 19-year-old man was referred to our clinic after being hit by a car five months ago while riding a bicycle. After the accident, he sometimes noticed oscillopsia, and had postural headaches and reading difficulties. His eye movement recording revealed square wave jerks during fixation and decreased pursuit gain during horizontal smooth pursuit. MR myelography detected cerebrospinal fluid leakage and the patient was diagnosed with cerebrospinal fluid hypovolemia. After undergoing epidural blood patch therapy, the leakage disappeared, and his postural headaches improved immediately. Square wave jerks and decreased pursuit gain improved, and his oscillopsia and reading difficulty also improved after therapy.
A patient with cerebrospinal fluid hypovolemia presented with square wave jerks and decreased pursuit gain. Epidural blood patch therapy was effective for the symptoms. When treating patients with oscillopsia and postural headaches, we should consider the possibility of cerebrospinal fluid hypovolemia syndrome in the differential diagnosis.