Diagnosis, Management, and Return-to-Play Following Spontaneous Lumbar Cerebrospinal Fluid Leak in an 18-Year-Old Female Volleyball Middle Blocker: A Case Study.
Faculty Mentor
Parry Gerber
Presentation Type
Poster
Start Date
4-14-2026 11:30 AM
End Date
4-14-2026 1:30 PM
Location
PUB NCR
Primary Discipline of Presentation
Exercise Science
Abstract
Context: Spontaneous cerebrospinal fluid (CSF) leaks are rare but clinically significant, causing intracranial hypotension and debilitating orthostatic symptoms. Recognition in young athletes is limited, and evidence guiding rehabilitation and return-to-play (RTP) following epidural blood patch (EBP) intervention is scarce. Objective: To describe the clinical presentation, diagnostic evaluation, management, interprofessional communication, and RTP outcomes of an 18-year-old collegiate volleyball athlete with a spontaneous lumbar CSF leak. Methods: This level 4 case study was conducted in a collegiate sports medicine setting. The athlete presented with acute orthostatic headache, nausea, photophobia, phonophobia, and exercise intolerance. Initial neurological and cardiovascular testing and MRI were nondiagnostic. CT myelography identified a right lateral L1–L2 diverticulum consistent with a Type II CSF leak. She underwent four fluoroscopically guided EBPs over five months. Rehabilitation included activity restriction followed by symptom-guided physical therapy emphasizing upright tolerance, core stabilization, progressive loading, and volleyball-specific retraining. Outcomes included headache severity, upright tolerance, functional capacity, and sport participation. Results: Symptoms improved progressively after each EBP, with greatest gains following the final two patches. Headache severity decreased to a mild baseline (3/10), and upright tolerance improved substantially. Rehabilitation progressed to full sport participation without symptom exacerbation. Objective testing demonstrated restoration of core endurance, postural control, and jump-landing mechanics. The athlete returned to unrestricted competition with minimal symptom recurrence. Conclusions: Targeted EBPs combined with structured rehabilitation enabled successful RTP. This case provides preliminary guidance for rehabilitation and RTP decision-making in athletes with spontaneous CSF leaks.
Recommended Citation
Aucutt, Ashley, "Diagnosis, Management, and Return-to-Play Following Spontaneous Lumbar Cerebrospinal Fluid Leak in an 18-Year-Old Female Volleyball Middle Blocker: A Case Study." (2026). 2026 Symposium. 13.
https://dc.ewu.edu/srcw_2026/ps_2026/p2_2026/13
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Diagnosis, Management, and Return-to-Play Following Spontaneous Lumbar Cerebrospinal Fluid Leak in an 18-Year-Old Female Volleyball Middle Blocker: A Case Study.
PUB NCR
Context: Spontaneous cerebrospinal fluid (CSF) leaks are rare but clinically significant, causing intracranial hypotension and debilitating orthostatic symptoms. Recognition in young athletes is limited, and evidence guiding rehabilitation and return-to-play (RTP) following epidural blood patch (EBP) intervention is scarce. Objective: To describe the clinical presentation, diagnostic evaluation, management, interprofessional communication, and RTP outcomes of an 18-year-old collegiate volleyball athlete with a spontaneous lumbar CSF leak. Methods: This level 4 case study was conducted in a collegiate sports medicine setting. The athlete presented with acute orthostatic headache, nausea, photophobia, phonophobia, and exercise intolerance. Initial neurological and cardiovascular testing and MRI were nondiagnostic. CT myelography identified a right lateral L1–L2 diverticulum consistent with a Type II CSF leak. She underwent four fluoroscopically guided EBPs over five months. Rehabilitation included activity restriction followed by symptom-guided physical therapy emphasizing upright tolerance, core stabilization, progressive loading, and volleyball-specific retraining. Outcomes included headache severity, upright tolerance, functional capacity, and sport participation. Results: Symptoms improved progressively after each EBP, with greatest gains following the final two patches. Headache severity decreased to a mild baseline (3/10), and upright tolerance improved substantially. Rehabilitation progressed to full sport participation without symptom exacerbation. Objective testing demonstrated restoration of core endurance, postural control, and jump-landing mechanics. The athlete returned to unrestricted competition with minimal symptom recurrence. Conclusions: Targeted EBPs combined with structured rehabilitation enabled successful RTP. This case provides preliminary guidance for rehabilitation and RTP decision-making in athletes with spontaneous CSF leaks.
