International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access
Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc
Journal website https://www.theijcp.org

Case Report

Volume 10, Number 4, December 2021, pages 78-82

A Case of Cerebrospinal Fluid Hypovolemia With Orthostatic Dysregulation

Figures

Figure 1.
Figure 1. Radioisotope (RI) cisternography images. RI cisternography images at 1, 3, 5, and 24 h after RI injection. Early bladder filling at 3 h (arrow) and decreased RI residual activity (20.7%) at 24 h were observed. ANT: anterior view; POST: posterior view.
Figure 2.
Figure 2. Postmyelography contrast computed tomography (CT). Axial CT showing bilateral extrathecal cerebrospinal fluid collections (arrows).

Tables

Table 1. Criteria of Orthostatic Dysregulation
 
The presence of either combined one major and three minor, combined two major and one minor, or three major manifestations indicates a high probability of orthostatic dysregulation.
Major manifestations
  A. Susceptibility to vertigo and dizziness on standing
  B. A tendency for fainting in the standing position, which in severe cases leads to a fall
  C. Nausea on taking a hot bath or on encountering unpleasant experiences
  D. Palpitation and/or dyspnea after mild exercise
  E. Difficulty in getting out of bed
Minor manifestations
  a. Pallor
  b. Anorexia
  c. Occasional umbilical colic (severe abdominal pain)
  d. Fatigability
  e. Frequent headache
  f. Motion sickness
  g. Decrease in pulse pressure of > 16 mm Hg during standing in the postural test
  h. Decrease in systolic blood pressure > 21 mm Hg during standing in the postural test
  i. Increase in pulse rate of > 21/min during standing in the postural test
  j. Decrease in TI, TII amplitude on electrocardiogram of > 0.2 mV during standing in the postural test

 

Table 2. Differentiation of Orthostatic Headache Between Cerebrospinal Fluid (CSF) Hypovolemia and Orthostatic Dysregulation (OD)
 
CSF hypovolemiaOD
Time to onset of headacheGradually after standing loadImmediately after standing load
PhotosensitivityPositiveNegative
Tinnitus/feeling of ear obstructionPositiveNegative
AnalgesicsNo effectNo effect
ExerciseExacerbationLight
Diurnal variation of symptomsExacerbation from afternoon to nightLight from afternoon to night