CSF (cerebrospinal fluid) Leak

Cerebrospinal fluid (CSF) surrounds your brain and spinal cord and provides a cushion to protect them from injury. 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.

There are two distinct types of CSF leaks with different symptoms, causes and treatments. These are spinal CSF leaks and cranial CSF leaks. A spinal CSF leak occurs anywhere in the spinal column. A cranial CSF leak occurs in the skull.

The most common symptom of a spinal CSF leak is a headache, while a cranial CSF leak causes symptoms such as clear fluid leaking from the nose or ear. Some CSF leaks may heal with conservative treatments such as bed rest. Many CSF leaks need a blood patch to cover the hole or surgery to repair the leak.

Symptoms

Symptoms vary between spinal and cranial CSF leaks.

Spinal CSF leaks

The most common symptom of a spinal CSF leak is headache. These headaches usually:

  • Cause pain in the back of the head

  • Improve when lying down

  • Worsen when standing up

  • May start or worsen with exertion (such as coughing or straining)

  • Rarely, start suddenly ("thunderclap" headache)

Other symptoms of spinal CSF leaks may include:

  • Neck or shoulder pain

  • Ringing in the ears (tinnitus)

  • Changes in hearing

  • Dizziness

  • Nausea or vomiting

  • Changes in vision

  • Changes in cognition or behavior

Cranial CSF leaks

Cranial CSF leak symptoms may include:

  • Clear, watery drainage from the nose or ear (on one side)

  • Hearing loss

  • A metallic taste in the mouth

  • Meningitis

Causes

Spinal CSF leaks may be caused by:

  • A lumbar puncture (spinal tap)

  • An epidural in the spine for pain relief, such as during labor and delivery

  • An injury to the head or spine

  • Bone spurs along the spine

  • Abnormalities of the dura mater around the nerve roots in the spine

  • Abnormal connections between dura mater and veins (CSF-venous fistulas)

  • Prior surgery on the spine

Cranial CSF leaks may be caused by:

  • A head injury

  • Increased pressure in the brain

  • Poorly functioning shunt

  • Malformations of the inner ear

Sometimes CSF leaks develop after very minor events:

  • Sneezing

  • Coughing

  • Straining to have a bowel movement

  • Lifting heavy objects

  • Falling

  • Stretching

  • Exercise

Sometimes a CSF leak doesn't have a known cause (spontaneous CSF leak).

Treatment
Options

Some CSF leaks improve with bed rest alone. Other CSF leaks may need treatment.

Treatments for spinal CSF leaks may include:

  • Epidural blood patch. This treatment involves taking a sample of your own blood, then injecting it into the spinal canal. The blood cells form a clot, which creates a patch to cover the area where the CSF is leaking.

  • Sealant. A special sealant may be used alone or mixed with your blood in the same technique described above to cover the hole and stop the CSF leak.

  • Surgery. Some CSF leaks need surgery, though surgery is only performed if the other treatment options don't work and the precise site of the leak is known. There are several types of surgical treatments that repair CSF leaks. Surgery may involve repairing the CSF leak with stitches or grafts made from patches of muscle or fat.

  • Trans-venous embolization. This is a new minimally invasive, catheter-based treatment for CSF-venous fistulas only that involves gluing shut the fistula from inside the culprit vein.

Some cranial CSF leaks, such as those caused by trauma, improve with conservative measures such as:

  • Bed rest

  • Elevating the head of the bed

  • Taking stool softeners to prevent straining

Most spontaneous cranial CSF leaks require surgery.

Schedule Your Consultation

If you are suffering from a CSF leak, the first step towards feeling better is to schedule an evaluation with an experienced ear, nose and throat doctor. Board certified and fellowship trained in rhinology, our physician at Sensa Health has extensive experience diagnosing and treating a wide variety of nose conditions. Call or text our office at 213-267-2256 to schedule an appointment today.