Cerebrospinal fluid leak

A condition where cerebrospinal fluid leaks from the brain or spinal cord

Injury

Cerebrospinal fluid leak
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Synonyms	CSF leak
Pronounce
Field	Neurology, Neurosurgery, Otolaryngology
Symptoms	Headache (worse when upright), nausea, neck stiffness, tinnitus, clear nasal discharge (CSF rhinorrhea), ear drainage (CSF otorrhea), photophobia
Complications	Meningitis, brain herniation, persistent neurological deficits
Onset	Sudden or gradual
Duration	Varies; may be acute or chronic
Types	Spontaneous or traumatic (including post-surgical)
Causes	Head trauma, spinal tap, surgery, spontaneous (idiopathic), connective tissue disorders (e.g., Marfan syndrome, Ehlers–Danlos syndrome)
Risks	Trauma, prior spine or sinus surgery, certain genetic conditions
Diagnosis	MRI with contrast, CT myelography, beta-2 transferrin test (for fluid analysis), nasal endoscopy
Differential diagnosis	Sinusitis, migraine, allergic rhinitis, intracranial hypotension
Prevention	Use of atraumatic needles in lumbar puncture, avoiding unnecessary spinal taps or trauma
Treatment	Bed rest, hydration, epidural blood patch, surgical repair if persistent
Medication	Caffeine for symptom relief, antibiotics if infection suspected
Prognosis	Good with appropriate management; persistent leaks can lead to serious complications
Frequency	Rare; spontaneous CSF leaks estimated at ~5 per 100,000 annually
Deaths	Rare; may occur from complications such as meningitis if untreated

A cerebrospinal fluid leak (CSF leak) is a medical condition where the cerebrospinal fluid (CSF) escapes from the subarachnoid space surrounding the brain and spinal cord. This can occur due to a tear or hole in the dura mater, the outermost layer of the meninges.

Causes

Cerebrospinal fluid leaks can be caused by a variety of factors, including:

• Trauma: Head injuries or spinal injuries can lead to tears in the dura mater.
• Surgical procedures: Certain neurosurgical or spinal surgeries may inadvertently cause a CSF leak.
• Spontaneous leaks: These occur without any apparent cause and may be related to underlying connective tissue disorders.
• Increased intracranial pressure: Conditions that increase pressure within the skull can lead to CSF leaks.

Symptoms

The symptoms of a cerebrospinal fluid leak can vary depending on the location and severity of the leak. Common symptoms include:

• Headache: Often described as a positional headache, worsening when upright and improving when lying down.
• Nasal drainage: Clear, watery fluid draining from the nose, especially when bending forward.
• Tinnitus: Ringing in the ears.
• Hearing loss: Changes in hearing, often due to pressure changes in the ear.
• Neck stiffness: Due to irritation of the meninges.

Diagnosis

Diagnosing a CSF leak involves a combination of clinical evaluation and diagnostic tests. These may include:

• Imaging studies: MRI or CT scan can help visualize the site of the leak.
• Beta-2 transferrin test: A laboratory test that detects the presence of CSF in nasal or ear fluid.
• Intrathecal fluorescein: A dye injected into the CSF to help identify the leak site during imaging.

Treatment

Treatment for a cerebrospinal fluid leak depends on the cause and severity of the leak. Options include:

• Conservative management: Bed rest, hydration, and caffeine intake to reduce symptoms and allow the leak to heal naturally.
• Epidural blood patch: A procedure where a small amount of the patient's blood is injected into the epidural space to seal the leak.
• Surgical repair: In cases where conservative measures fail, surgical intervention may be necessary to repair the dura mater.

Prognosis

The prognosis for individuals with a cerebrospinal fluid leak varies. Many leaks resolve with conservative treatment, but some may require surgical intervention. Early diagnosis and treatment are crucial to prevent complications such as meningitis.

Related Pages

• Meninges
• Intracranial pressure
• Neurosurgery
• Spinal cord