The fluid that surrounds and protects the spinal cord and brain from injuries is called cerebrospinal fluid (CSF). Normally, people have three layers that surround the brain and spinal cord. CSF leak happens usually when there is a hole or tear in the outermost layer. The fluid begins to leak when the outer layer has a tear or hole. This layer is called dura mater.
However, there are two types of this condition such as cranial CSF leaks and spinal CSF leaks. Moreover, each one has different causes, symptoms, and treatments. While spinal CSF leaks may happen anywhere in the spinal column and the most common symptom is headaches, cranial CSF leaks happen in the skull, and in most cases, it causes clear fluid leaking from the ear or nose.
Furthermore, there are some CSF leaks that may heal with rest, but most of them require treatment to repair a hole or tear that allows CSF to leak.
Symptoms
The symptoms usually are different among people with cranial and spinal CSF leaks. Check below some examples:
Spinal CSF Leaks
- Back of the head pain
- The headache improves when lying down and worsens when standing up
- Cough also may worsen the headache
- Suddenly headache (this symptom occurs rarely)
- Nausea
- Vomiting
- Vision and hearing changes
- Neck or shoulder pain
- Dizziness
- Behavioral changes
Cranial CSF Leaks
These include:
- Metallic taste in the mouth
- Hearing loss
- Meningitis
- Watery drainage from one side of the nose or ear
If any of the symptoms listed above occur, immediately contact your healthcare professional.
Causes
Spinal CSF Leak Causes
- Head or spine injuries
- Abnormalities of the dura mater
- CSF-venous fistulas (irregular connections between veins and dura mater)
- Spine surgery
- Bone spurs along the spine
- Epidural in the spine (it is usually used during labor and delivery
- Lumbar puncture (also known as spinal tap)
Cranial CSF Leak Causes
- Head injury
- Increased pressure in the brain
- Inner ear malformations
- Sinus surgery
Sometimes, people develop this condition after some minor events. For example:
- Cough
- Sneeze
- Straining to have a bowel movement
- Falls
- Stretching
- Heavy liftings
- Intense exercise
When people develop CSF leaks without previous surgeries or procedures, the condition is called spontaneous CSF leak.
Risk Factors
Healthcare providers identified multiple factors that could elevate your risk of developing cerebrospinal fluid leak. These include:
- Surgeries on or around the spine
- Connective tissue disorders (including Ehlers-Danlos syndrome, Marfan syndrome, and others)
- Obesity
- Obstructive sleep apnea
- Head trauma
- Skull base tumors
- Abnormalities of the inner ear or skull base
- Previous skull surgeries
What Are The Potential Complications of Cerebrospinal Fluid Leak?
If the disease is left untreated, it may lead to certain complications. These include:
- Meningitis
- Tension pneumocephalus (a condition in which the air enters the space that surrounds the brain)
- Subdural hematomas
- Bleeding on the brain surface
- Seizures
- Blindness
- Hydrocephalus
Talk with your doctor about ways to reduce the risk of CSF leak complications.
Diagnosis
Healthcare providers use the following tests and procedures to diagnose cranial and spinal CSF leaks. Check below some examples:
Spinal CSF Leak
- MRI (magnetic resonance imaging) with gadolinium – This test is used to get detailed pictures of the brain, spinal cord, and other body parts. Gadolinium is a substance that highlights tissue in the body. It is also called a contrast agent.
- Radioisotope cisternography – This is a specific test that involves the measurement of CSF pressure.
- Myelography – This is an imaging test that uses a contrast dye and X-rays or CT (computerized tomography) to make detailed images of the spine.
- Spinal tap – This procedure is also known as lumbar puncture and it involves a needle that is placed in the spinal column to measure the CSF pressure inside it.
Cranial CSF Leak
The diagnosis of this CSF leak type begins usually with an evaluation of the medical history and a physical examination to check for abnormalities linked with the CSF leak. For example nasal discharge and others. Check below some tests often used to diagnose cranial CSF leaks:
- MRI with gadolinium
- Tympanometry – This test uses a specific device to measure the middle ear function and check for fluid. If you experience a clear discharge from the ear, it may indicate a CSF leak.
- CT cisternography – In most cases, this test is used to diagnose this condition and locate the CSF leaks.
Treatment
While some CSF leaks may go away with rest, others require treatment. Check below some treatments that usually are prescribed by doctors for people with CSF leaks:
- Epidural blood patch – It involves taking a sample of the blood and then injecting it into the spinal canal. Thereafter, blood cells form a clot that covers the area where CSF is leaking.
- Fibrin sealant – This is a special glue made from human plasma substances to help the blood clotting process. Therefore, it is injected into the spinal canal to interrupt CSF leak.
- Surgery – Some people with CSF leaks need surgery to repair it. The holes or tears in the dura mater are usually repaired with grafts or stitches produced from patches of fat or muscles.
- Trans-venous embolization – It is a minimally invasive treatment used only for people with CSF-venous fistula. Irregular connections that happen in the spine, allow the CSF fluid to leak into the bloodstream.
Sometimes, people with cranial CSF leaks get better with conservative measures only. For example:
- Bed rest
- Elevating the bed head
- Administering stool softeners to prevent straining
Frequently Asked Questions
What are the symptoms of cerebrospinal fluid leak?
For example:
- Headache
- Nausea
- Hearing and vision changes
- Vomiting
- Neck pain or stiffness
- Increased sound and light sensitivity
- Behavioral changes
If any of the previous symptoms occur or any others that cause concerns, visit a doctor right away.
What happens if a cerebrospinal fluid leak is left untreated?
Those who ignore the symptoms and do not get treatment for this condition may experience certain complications. Examples include:
- Meningitis
- Deep vein thrombosis
- Brain herniation
- Seizures
- Blood pressure issues
- Transient paralysis
- Cerebral venous thrombosis
- Subdural hematomas
Talk with your healthcare professional about ways to reduce the risk of CSK leak complications.
What can be mistaken for a CSF leak?
Sometimes, some conditions can be mistaken for CSF leaks. Examples include:
- Allergies
- Postural orthostatic tachycardia syndrome (POTS)
- Sinus infections
- Migraines
- Cervicogenic headache
- Orthostatic hypotension
- Vestibular migraine
This article does not contain all possible conditions that can be mistaken for CSF leaks. If you have additional questions, ask your healthcare provider.
