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Hypoliquorreic headache and pneumocephalus caused by thoraco-subarachnoid fistula

Departments of Neurology, Surgery and Radiology, Tucson Veterans Administration Hospital and University of Arizona, Tucson, Arizona.

One month after having a right upper lobectomy to remove a squamous cell carcinoma, a 43-year-old man presented with a 4-day history of postural headache, worsened by standing and relieved by lying. Skull films showed prominent ventricular pneumocephalus. lophendylate myelography was unrewarding, but isotope cisternography revealed a CSF fistula at the T4 level, extending into the thoracic cavity. Thoracoplastic removal of the first four ribs successfully prevented air passage and the patient had a rapid uneventful recovery.

Dr. Labadie's address is Department of Neurology, Veterans Administration Hospital, Tucson, AZ.

Accepted for publication November 19, 1976.

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