A fibromyalgia patient with traumatic cerebrospinal fluid leak: a case report

Abstract

We present a fibromyalgia patient with traumatic cerebrospinal fluid (CSF) leak. A woman was referred because of widespread pain, general fatigue, dizziness, nausea, vomiting, and deterioration of memory after a traffic accident. These signs and symptoms in a sitting or standing position were more deteriorated than in a recumbent position. Although she was diagnosed with fibromyalgia, her widespread pain was unusually severe. She was diagnosed with traumatic CSF leak based on radioisotope cisternography. Her widespread pain was slightly decreased after epidural blood patches, but the nausea completely disappeared and dizziness was eased. A second radioisotope cisternography revealed that the leak of cerebrospinal fluid was discontinued. CSF leak is characterized by headache, nausea, dizziness, and visual impairment. The symptoms and signs resemble Barre-Lieou syndrome. Another characteristic is that these symptoms and signs in a sitting or standing position are more deteriorated than in a recumbent position. Fibromyalgia after trauma is sometimes comorbid with traumatic CSF leak. Radioisotope cisternography is essential for diagnosis. It demonstrates direct findings such as radioisotope leak into the spinal epidural space and indirect findings such as early bladder filling and/or the rapid disappearance of radioisotopes from the CSF space. A beneficial treatment is an epidural blood patch. Patients with fibromyalgia and traumatic CSF leak are likely to suffer more severe signs and symptoms such as increased widespread pain than patients with fibromyalgia alone. Patients with fibromyalgia and traumatic CSF leak are often refractory to treatment.