Spontaneous Low Csf Volume Headache with Abducens Nerve Palsy

The syndrome of spontaneous low CSF volume headache is caused by spontaneous or traumatic leaks of the CSF from the subarachnoid space. The CSF hypovolaemia causes sagging of the brain and traction of cranial nerves leading sometimes to overt cranial nerve palsies. We report three cases of this syndrome, in which abducens nerve palsy developed after postural headache in two patients, and neck ache in the third. In one patient, symptoms started after a mild head injury. Head MRI showed typical dural thickening and enhancement in all and bilateral subdural hygromas, and downward displacement of cerebellar tonsils in two patients. Epidural blood patch was performed in one patient, and produced significant improvement of symptoms within hours of the procedure. The diagnosis of spontaneous low CSF volume headache should be considered in patients who present with abducens nerve palsy in association with headache and or neck ache, especially if the headache is postural.