Cerebrospinal fluid (CSF) hypovolemia is a neurological syndrome which may appear incidentally in a psychiatric illness setting. Patients with CSF hypovolemia may present with intractable and indefinite complaints. Herein, we report a patient with CSF hypovolemia who was admitted to the psychiatric ward. The patient, a 43-year-old housewife, complained of various physical symptoms, including vertigo, tinnitus, headache, heaviness in the head, and a feeling of the ringing in the head (sounding like “Shuwan Shuwan”). The persistence of these symptoms secondarily led to strong anxiety and depression. At first, the patient was diagnosed with schizophrenia. She required prolonged hospitalization because the antidepressive and anxiolytic agents prescribed had insufficient effects. However, she was eventually diagnosed with CSF hypovolemia. Treatment with an epidural blood patch resulted in improvement of her physical and psychiatric symptoms. Thus, psychiatrists must bear in mind the possibility of CSF hypovolemia on diagnosing patients presenting with the abovedescribed symptoms.
A Case of Cerebrospinal Fluid (CSF) Hypovolemia Diagnosed in a Psychiatric Ward
Department of Psychiatry, School of Medicine, Jichi Medical University
Psychiatria et Neurologia Japonica
110: 362-369, 2008
Accepted in revised form: 30 May 2008.
Accepted in revised form: 30 May 2008.
<Keywords:cerebrospinal fluid (CSF) hypovolemia, headache, differential diagnosis, depression, panic disorder>