Objective:

To present an atypical case of a spontaneous traumatic cerebrospinal fluid (CSF) leak following repetitive mid-back impacts during wrestling training.

Background:

CSF leaks can result from spinal trauma, even minor events, and are often associated with dural weakness from dural ectasia or meningeal diverticula. Dural ectasia may occur in connective tissue disorders such as Marfan syndrome. In some cases, no structural abnormality is identified, and a spontaneous dural tear is presumed.

Design/Methods:

N/A

Results:

A 32-year-old female with history of tension-type headaches presented to the hospital with an acute onset of intractable headaches with photophobia, nausea, vomiting – distinct from her typical headaches. The pain worsened with sitting or standing and improved when supine. Initially, she denied recent spinal procedures or significant trauma. Symptoms mildly improved with intravenous caffeine, fluids, and a migraine cocktail (including acetaminophen, ketorolac, metoclopramide). The MRI brain showed small ventricles without other abnormalities. MRI thoracic spine revealed dorsal extradural fluid signal extending from T3 through T10-11, suspicious for CSF leak, without evidence of fracture or structural defect. On further questioning, she reported repetitive mid-back falls during wrestling training approximately 1.5 weeks prior to symptom onset. Her headache resolved completely following an epidural blood patch. Rheumatologic evaluation, including clinical signs and symptoms, ANA, complement levels, rheumatoid factor, and anti-CCP antibodies, was unremarkable, suggesting low likelihood of an underlying connective tissue or autoimmune disorder.

Conclusions:

This case highlights that recurrent minor trauma, such as repeated back falls during athletic activity, can precipitate a spinal CSF leak even in the absence of identifiable connective tissue disorders or structural abnormalities. Clinicians should maintain a high index of suspicion for CSF leak in patients with orthostatic headaches, even when the trauma appears trivial, to enable timely diagnosis and effective treatment.