A Case of Cerebrospinal Fluid Hypovolemia with Orthostatic Dysregulation

We present the case of a previously healthy 13-year-old boy with cerebrospinal fluid (CSF) hypovolemia followed by orthostatic dysregulation (OD). OD is a clinical entity that presents with various symptoms, such as vertigo when standing up, syncope during standing, and palpitation. The essential mechanism of CSF hypovolemia is thought to be that CSF leakage at the spine level decreases the volume and pressure of the CSF. The causes of CSF hypovolemia in children remain unclear, and patients with this condition complain of symptoms, such as orthostatic headache, vertigo, and tinnitus; therefore, it is represented by OD. Our patient’s symptoms began with an orthostatic headache. Consequently, the patient was diagnosed with OD using the orthostatic test. He was treated with midodrine, but his symptoms did not improve. Thereafter, he was diagnosed with CSF hypovolemia using radioisotope cisternography and computed tomography myelography. Epidural blood patch treatment was performed, after which his symptoms improved, and he was able to return to school life. Some patients with CSF hypovolemia are often misdiagnosed with OD, autonomic nervous system dysfunction, or psychiatric disorders. Therefore, it is important to note that CSF hypovolemia is not rare in children and that it may be found among children with OD, chronic daily headaches, and indeterminate complaints, which interfere with school and daily activities. Int J Clin Pediatr. 2021;10(4):78-82 doi: https://doi.org/10.14740/ijcp460