Skip to main content
AAPM&R 2025 Main banner
JFK
Final Program


Official Program
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
On Demand
On Demand
In-Person
In-Person
Livestream
Livestream
Invite Only
Invite Only
Ticketed
Ticketed
Coffee Break
Coffee Break
Meal
Meal
Reception
Reception
Rate ePoster

Neurological Rehabilitation

Preoperative CSF Leak as a Rare and Underrecognized Cause of Progressive Neurological Decline in Cervical Spinal Cord Injury: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Case Report Theater

    Primary Author(s)

  • Steven Le, MD

    Resident Physician
    Schwab Rehabilitation Hospital & Care Network/University of Chicago PM&R Program
    Chicago, Illinois

    • Co-Author(s)

  • MG

    Michelle Gittler, MD

    Medical Director, Chair, Program Director
    Schwab Rehabilitation Hospital & Care Network/University of Chicago PM&R Program
    Chicago, Illinois

Disclosure(s):
Steven Le, MD: No financial relationships to disclose
Case Diagnosis: 69-year-old male patient with acute traumatic cervical SCI with progressive neurological decline secondary to preoperative CSF leak

Case Description or Program Description: Patient presented after a traumatic fall down 15 stairs. CT scan C-spine revealed fractures from C1 to C7. MRI demonstrated an anterior epidural hematoma from C2 to C5. Neurosurgery recommended non-operative external immobilization with C-collar. Initial PM&R consultation 24 hours after hospitalization demonstrated right elbow extensor weakness (3+/5). Repeat examination with progressive neurological deficits, including less than antigravity weakness of bilateral elbow extensors, finger flexors, and abductors, and sensation deficit to pinprick in the right C7, C8, and T1 dermatomes. Neurosurgery was alerted and performed emergent C6-C7 laminectomy and C5-T2 fusion.

Setting: Acute Inpatient Hospitalization

Assessment/Results: Operative findings revealed a significant CSF leak originating anteriorly at C5-C6, not visible posteriorly. This was identified after removal of the lamina, ligamentum flavum, and evacuation of the hematoma, confirming the leak was from an anterior source while the posterior dura remained intact. This patient required rehabilitation secondary to incomplete tetraplegia secondary to fall.

Discussion (relevance): In acute cervical SCI, progressive neurological deficits should raise concern for: spinal cord edema, ischemia, infection, expanding hematoma, and unstable fractures. In this case, a CSF leak was likely the primary cause of symptom progression, given the absence of hematoma expansion. Standard MRI may not detect CSF leaks, particularly if anterior and not extending into the posterior epidural space. Therefore, physical exam findings are essential for detecting and monitoring progressive neurological symptoms.

Conclusions: This case highlights CSF leaks as an exceptionally rare and underrecognized mechanism of unexplained neurological deterioration in SCI, particularly in the absence of prior surgical intervention. Increased suspicion with detailed physical reexamination is essential to ensure timely recognition and intervention.