A CSF leak occurs when cerebrospinal fluid (CSF) escapes from the protective layer surrounding the brain and spinal cord. This is a serious condition that can cause headaches, seizures, or meningitis. A CSF leak needs to be treated by a medical professional.
Cerebrospinal fluid (CSF) is a clear liquid that surrounds the brain and spinal cord. Its role is to supply nutrients to these areas and to cushion the brain inside the skull.
The brain is covered in thin layers of tissue collectively called the meninges, and CSF can escape through a tear in this tissue. The fluid may then leak from the nose or ears or into other parts of the body. Also, CSF in the spine can leak into muscles and connective tissue surrounding the spinal column.
A CSF leak is a serious issue that can cause complications such as headaches, meningitis, and seizures.
This article describes the causes and symptoms of a CSF leak. It also looks into how doctors diagnose and treat the issue and what to expect during recovery.
The
Other symptoms of a CSF leak include:
- nausea
- neck pain
- tinnitus, or ringing in the ears
- hearing loss
An individual with a CSF leak may also notice clear, watery fluid draining from their nose or ears when they move their head, especially when bending forward. CSF may also drain down the back of the throat. People describe the taste as salty and metallic.
The
A bone spur on the vertebral body or disc can also tear the dura and cause a leak.
Other causes of a CSF leak — in the skull or spine — include:
- infection
- an epidural injection
- an anesthetic injection
- intracranial hypertension
- venous fistula
- a lumbar puncture
- brain tumors
- surgery on or around the base of the skull or spine
- structural abnormalities of the skull that have been present from birth
A doctor can use several tests to diagnose a CSF leak. The most common is a beta-2 transferrin test performed on the suspected fluid.
Beta transferrin is a protein normally only found in CSF fluid. Its presence can confirm a CSF leak.
If a doctor suspects a CSF leak, they may order a CT or MRI scan to help confirm the diagnosis and locate the leak.
Treatment for a CSF leak
Conservative treatments
Conservative treatments mainly focus on managing symptoms. These treatments may include:
- bed rest with head elevated around 30 degrees
- avoiding nose-blowing or sneezing
- using stool softeners to avoid straining
- staying hydrated
- taking over-the-counter or prescription pain relief medication
- taking acetazolamide via prescription in cases of intracranial pressure
A CSF leak that does not respond to conservative treatment may require more invasive approaches, such as those below.
Lumbar drain
A lumbar drain slowly removes some CSF fluid, reducing pressure at the site of the leak. This gives the dura time to heal. Doctors may recommend this in cases of a CSF leak with increased intracranial pressure.
In this procedure, a tube connected to a drainage bag is inserted in the CSF compartment at the base of the person’s back. A needle is inserted into the back; then the lumbar drain catheter is placed through the needle. When the catheter is in place, the needle is removed.
An epidural blood patch
An epidural blood patch is a surgical procedure in which a person’s blood is used to patch tears in the dura mater.
During the procedure, the surgeon draws
Surgery
A doctor may recommend surgery if a person has:
- a CSF leak that does not improve with conservative treatment
- a severe CSF leak that is unlikely to heal on its own
- blood clotting in the brain or spinal cord
- herniated brain tissue
- meningitis
Surgery involves using grafts and adhesives, if necessary, to prevent further CSF leakage.
The specific approach depends on the location of the tear. For example, if a tear is in dura mater at the front of the head and causes the fluid to leak through the nose, an otolaryngologist may perform an endoscopic repair.
A person should consider seeing a doctor if they experience any of the following symptoms of a CSF leak:
- a persistent runny nose
- drainage from the ears
- a headache that worsens when the head is upright
Also, anyone who experiences symptoms of a CSF leak following any of the following should seek medical attention:
- a head injury
- a recent epidural
- brain surgery
- spinal cord surgery
Recovery depends largely on the severity of the leak and the type of treatment.
People who receive conservative treatment can expect to stay in bed for at least 3 days. The doctor may recommend keeping the head elevated to encourage CSF drainage, as well as precautions against nose-blowing or straining on the toilet.
Complications
However, if the fluid drains too quickly, pockets of gas—called cranial aerosols—can form inside the skull.
Other potential complications of a CSF leak include:
Early and accurate diagnosis of a CSF leak can lead to better treatment outcomes and help prevent complications.
If symptoms do not improve within 10 days of conservative treatment, or if they return, a more invasive intervention may be necessary.
Both epidural blood patches and surgical procedures have relatively high success rates. However, they may not always work. Even after surgery, some people continue to experience symptoms or disability resulting from CSF leakage.
A doctor or another healthcare professional specializing in neurological conditions can discuss the options and recommend a course of treatment.
A CSF leak is a serious health issue. It involves this type of fluid escaping through a tear in the dura mater.
The symptoms of a CSF leak include fluid drainage from the ears or nose and a headache that worsens when the head is upright.
These leaks can result from head injuries, infections, and certain medical procedures. Although this issue may not cause alarming symptoms, it can lead to complications if the person does not receive appropriate treatment.
The right treatment varies, depending on factors specific to each person. Early conservative treatment usually involves bed rest and hydration. If symptoms do not improve within 10 days, the person may require a more invasive procedure, such as an epidural blood patch or surgery.