Clinical case report: headache due to cerebrospinal fluid hypotension treated with caffeine

Case presentation: A 16-year-old male patient with a previous history of WHO Grade IV Medulloblastoma in the posterior fossa, resected at age 14, also submitted to radiotherapy and adjuvant chemotherapy. He sought medical attention referring episodes headache associated orthostatic position, criteria for hospitalization. Upon evaluation, reported continuous headache, biparietal occipital location, fatigue, nausea, dizziness blurred vision, refractory analgesia. presented ataxia, diplopia preserved ocular motricity, without other alterations. During hospitalization, brain neuraxial images showed no relevant changes. Lumbar puncture spinal manometry cerebrospinal fluid (CSF) hypotension, an opening pressure 10 cmH2O measured lateral decubitus, thus establishing diagnosis due CSF hypotension. Clinical measures were taken provide analgesia, little response. Scintigraphy cisternography was performed, signs suggestive leak. It decided associate oral caffeine citrate, dose 200 mg day, drug regimen. Then, progressive decrease orthostatism, presenting hospital discharge outpatient follow-up. At this time, instructed consume coffee during meals, except night, anhydrous prescribed orally 100 daily. After that, remained new until present moment.