Recurrent spontaneous spinal cerebrospinal fluid leak associated with "nude nerve root" syndrome: case report

Neurosurgery. 2003 Nov;53(5):1216-8; discussion 1218-9. doi: 10.1227/01.neu.0000089483.30857.11.


Objective and importance: Spontaneous spinal cerebrospinal fluid (CSF) leaks have been noted occasionally at multiple sites in the same patient, but recurrent spontaneous spinal CSF leaks have not been documented. We describe a patient with a recurrent CSF leak who was found at surgery to have an absence of the entire nerve root sleeve at multiple thoracic levels.

Clinical presentation: A 29-year-old woman bodybuilder noted an excruciating orthostatic headache associated with nausea. The neurological examination was unremarkable, and a magnetic resonance imaging examination showed the typical changes of intracranial hypotension. Computed tomographic myelography showed an extensive bilateral lower cervical CSF leak.

Intervention: The patient underwent bilateral lower cervical nerve root explorations, and several small dural holes were found. The CSF leaks were repaired, but 3 months later, computed tomographic myelography showed a new CSF leak in the midthoracic area. A thoracic laminectomy was performed, and several nerve roots were found to be completely devoid of dura. After the CSF leaks were repaired, there was significant improvement in her headaches.

Conclusion: A recurrent spontaneous spinal CSF leak may occur in patients with intracranial hypotension at a site previously documented not to be associated with a CSF leak. Absent nerve root sleeves may be found in patients with spontaneous spinal CSF leaks ("nude nerve root" syndrome), and these patients may be at increased risk of developing a recurrent CSF leak.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Female
  • Humans
  • Intracranial Hypotension / diagnosis*
  • Intracranial Hypotension / surgery
  • Recurrence
  • Spinal Nerve Roots / abnormalities*
  • Spinal Nerve Roots / surgery
  • Subdural Effusion / diagnosis*
  • Subdural Effusion / surgery