Management of cervical CSF-venous fistula causing acute cognitive impairment and coma

Lalani Carlton Jones*, Jan Hoffmann, Saamir Mohideen, Biba Stanton, Cristina Bleil, Tom Britton, Peter J. Goadsby, Bassel Zebian

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


CSF-venous fistulas (CVFs) are increasingly recognised as a cause of spontaneous intracranial hypotension. They may present atypically including with brain sagging pseudo-dementia. Cervical CVFs are rare and their management can be difficult due to associated eloquent nerve roots. We report the case of a 49-year-old woman who presented with cognitive decline progressing to coma. Brain imaging showed features of spontaneous intracranial hypotension and a right C7 CVF was identified at digital subtraction and CT myelography. Initial treatment with CT-guided injection of fibrin sealant produced temporary improvement in symptoms before surgical treatment resulted in total clinical remission and radiological resolution.

Original languageEnglish
Article number37
JournalActa Neurochirurgica
Issue number1
Early online date26 Jan 2024
Publication statusE-pub ahead of print - 26 Jan 2024


  • CSF-venous fistula
  • Frontotemporal dementia
  • Spinal CSF leak
  • Spontaneous intracranial hypotension


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