Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

Cerebrospinal fluid leakage and abducens nerve palsy caused by bowling activity

Hiroyasu Inoue, M.D.1), Masaya Takemoto, M.D.2), Masahiro Muto, M.D.3), Taro Kitamura, M.D.1) and Kentaro Yamada, M.D.1)

1)Department of Neurology, Nagoya City East Medical Center
2)Department of Neurosurgery, Social Insurance Chukyo Hospital
3)Department of Radiology, Nagoya City East Medical Center

Cerebrospinal fluid leakage can develop due to traffic trauma or lumbar puncture; however, in many cases, it develops spontaneously without any obvious cause. This report describes a case of cerebrospinal fluid leakage caused by bowling activity. A 57-year-old woman adjusted her bowling form, which led to the development of an orthostatic headache and double vision. Cerebrospinal fluid leakage and right abducens nerve palsy was diagnosed, which was resistant to conservative treatment. An epidural blood patch was performed, leading to an improvement in the headache and abducens nerve palsy. The hypotension and nerve palsy may have been caused by small amounts of cerebrospinal fluid leakage due to repeated traction of the brachial plexus and nerve root resulting from an irregular bowling form. To the best of our knowledge, there are no reported cases of cerebrospinal fluid leakage caused by bowling; therefore, this is a valuable case to investigate the mechanism of onset. Similar mechanisms may have remained undiscovered in other cases of spontaneous intracranial hypotension.
Full Text of this Article in Japanese PDF (417K)

(CLINICA NEUROL, 58: 202|205, 2018)
key words: cerebrospinal fluid leakage, orthostatic headache, abducens nerve palsy, bowling, intracranial hypotension

(Received: 27-Nov-17)