Dizziness and other symptoms of cerebrospinal fluid leakage and insights into their pathogenesis

Postural, tension-type headache is the most prominent symptom of cerebrospinal fluid leakage. However, in otoneurological practice, dizziness and not headache is the most frequent presenting symptom in patients with this disorder. Affected patients usually describe their dizziness as a floating sensation. Rotatory vertigo occurs quite rarely. Their complaint is substantiated by high degrees of postural unsteadiness. Some patients cannot stand still even with their eyes open. They stumble and totter while walking. In contrast to such high degrees of postural ataxia, oculomotor disorders such as nystagmus, saccadic pursuit, and decrease of oculomotor nystagmus are not seen. As with other symptoms, dizziness and postural unsteadiness are influenced by the weather, and get worse when the weather is bad. The authors speculate that unsteadiness in both peripheral and central nervous systems involved in spatial orientation (integration of visual, vestibular, and proprioceptive input) underlies the dizziness, postural unsteadiness, and a variety of other symptoms of cerebrospinal fluid leakage.