A patient who sustained an isolated transverse sacral fracture is presented. A large ventral sacral pseudomeningocele with cerebrospinal fluid (CSF) fistula developed. Eighteen previous cases of traumatic pseudomeningocele have been documented. A review of those cases leads these authors to conclude that: (a) transverse sacral fractures are rare and have not been reported in association with a pseudomeningocele formation; (b) at the 4h sacral vertebra, this is the lowest reported pseudomeningocele; and (c) CSF fistula with sacral fracture is distinctly uncommon, reported in only one previous case. The presenting symptoms, diagnostic evaluation, treatment, and prognosis are discussed.