A cerebrospinal fluid (CSF) leak is when you’re leaking the fluid that surrounds your brain and spinal cord.
Your brain and spinal cord have a surrounding protective layer of cerebrospinal fluid (CSF). CSF contains nutrients that your brain can use.
The CSF layer also supports and cushions your brain and spinal cord from sudden movements.
A leak of this fluid can cause very severe symptoms as the brain and spine does not get the nutrients it needs and the protection the brain and the spinal cord require, however in most cases it is treatable.
The spinal cord and CSF are surrounded by three layers of membranes.
A CSF leak occurs when there is a hole or tear in the outermost layer of these membranes (dura mater), which allows some of the fluid to escape.
One can have a small CSF leaks to large CSF leaks with variable symptoms.
There are spinal CSF leaks and cranial CSF leaks.
A spinal CSF leak occurs anywhere in the spinal column and the main symptoms is a discharge from nose and/or ear.
A CSF leak occurs in the skull and its main symptom is a severe headache.
Large CSF leak causes a drop in fluid pressure inside your head that causes a rare condition known as intracranial hypotension.
If the leak is large enough to cause intracranial hypotension, your brain will sink downward in your skull, putting too much pressure on its lower sections. That can disrupt how those parts of your brain work, causing symptoms ranging from minor and barely noticeable to severe and unbearable.
Diagnosis test
CSF leak symptoms specific to your nose or face (especially a runny nose):
Beta-2 transferrin test – this test looks for tau, a protein found in CSF but not in nasal mucus.
Glucose test, as CSF has about the same amount of glucose as your blood, while nasal mucus has little-to-no glucose.
Other tests include:
Computerized tomography (CT) scans
Magnetic resonance imaging (MRI) scans
Myelography
Cisternography
Lumbar puncture (spinal tap)
Cause
Injury:
Injuries to your face, head, neck or spine.
A common example of this is injuries from car crashes.
The most likely injuries involve your nose, sinuses, ears, temples or the base (bottom) of your skull
Twisting or severe whiplash can also cause tears that leak CSF fluid near your spinal cord
Penetrating injuries (like puncture or stab wounds, gunshot wounds)
Injuries from brain surgery
Injuries from ear, nose and throat medical procedures.
Injuries from medical procedures on or around your spine, such as epidural anesthesia and spinal taps (lumbar punctures).
Connective tissue disorders that could cause a weakness in the layers of tissue that should contain the CSF (examples include Marfan syndrome and Ehlers-Danlos syndrome).
Intracranial hypertension (high pressure inside your skull), which can cause tears in the surrounding tissue, creating a leak.
Pseudotumor cerebri (false brain tumors).
Obesity (especially class II or class III obesity).
Structural defects in how your nose, sinuses or other parts of your skull formed (either that you had when you were born or that developed or happened at some point in your life)
Severe headaches especially when changing posture position (A postural headache with a CSF leak worsens when you sit up or stand and improves when you lie down)?
Pain in the back of head (spinal CSF)?
Improve when lying down (spinal CSF)?
Worsen when standing up (spinal CSF)?
May start or worsen with exertion (such as coughing or straining) (spinal CSF)?
Sensitivity to every day noise and/or ringing noise within and/or difficulty hearing (click one’s finger and see if baby/young child responds) and/or Vertigo (spinal CSF)?
Runny nose (rhinorrhea) with thin, clear fluid normally one side (Cranial CSF)?
If you wipe your nose with a handkerchief, drying nasal mucus will cause the cloth to stiffen, but CSF won’t (Cranial CSF)?
Runny nose may happen under certain circumstances: such as when you bend over to pick something up or tie your shoes?
Loss of sense of smell (anosmia)-this usually happens with a CSF leak due to an injury to your face?
Clear fluid coming out of your ears (otorrhea) normall one side (Cranial CSF)?
Changes in hearing or hearing loss -this happens for similar reasons as double vision, with position changes putting strain or stress on the nerves connected to your ears (Cranial CSF)?
Pulsatile tinnitus- this is being able to hear your own pulse without using some kind of medical instrument or other means?
Blurred or double vision (diplopia)-This can happen when downward pressure on your brain causes problems with the ocular nerves, which connect to your eyes?
Photophobia (light sensitivity)?
Clear fluid coming out of eyes (mistaken for conjunctivitis) (Cranial CSF)?
A metallic taste in the mouth (Cranial CSF)??
Neck pain and upper back stiffness (spinal CSF)?
Loss of appetite?
Abdominal pain and/or are constant violently vomiting or vomiting longer than two days (one day if a child)?
Seizures -these are most likely to happen with large CSF leaks or those that cause severe intracranial hypotension?
Complications /Information to beware of/General tips:
Headache is worse when upright and improves when lying down.
Usually occurs within 15 minutes of assuming the upright position and is relieved after lying down within 15-30 minutes, However, It may take hours to worsen or improve with change of position.
Other characteristic symptoms include:
Neck pain
Neck stiffness
Nausea and vomiting
Sensitivity to light
Visual changes
Facial numbness or pain, or changes in taste
Sense of imbalance, dizziness or vertigo
Ringing in the ears
Changes in hearing and sensitivity to sound
Profound fatigue
Pain between the shoulder blades and into the upper arms
Non surgical use treatment
Minor small leaks will heel on their own.
This treatment calls for a person to lie down and rest for a period of time.
Elevating the head of the bed.
One will also need to stay hydrated and medications to treat inflammation and pain are common (under medical supervision).
Taking stool softeners to prevent straining (under medical supervision).
Caffeine and salt may also be part of the treatment guidelines in cases where a leak causes low CSF pressure (under medical supervision).
If conservative treatment doesn’t work after one to two weeks, your provider will likely recommend moving to direct treatments (surgery and/or blood patch injections).
CSF leaks can last days, weeks or even months, depending on the size of the leak and why it happened.
Treatment can also greatly shorten how long you feel the effects of a CSF leak.
Please talk to your healthcare professional (i.e. Medical Doctor/Pharmacist) for further advice
Detailed Information
Please copy and paste any key words from the title: Cerebrospinal fluid leak (CSF) in the following respective 'Medtick References and/or Sources' to find out more about the disease (this also may include diagnosis tests and generic medical treatments).
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