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CSF leak (Cerebrospinal fluid leak): Causes-Symptoms-Diagnosis-Treatment


What is CSF leak (Cerebrospinal fluid leak)?

brain and funiculus from injury and additionally is a nutrient delivery and waste removal system for the brain. CSF is factory-made unceasingly in areas of the brain referred to as ventricles and is absorbed by the blood.

Cerebrospinal fluid (CSF) leak happens once CSF escapes through a little tear or hole within the outer layer of animal tissue (called the dura mater mater) that surrounds the brain and funiculus and holds within the CSF. The tear or hole permits the CSF to break.

What is CSF leak (Cerebrospinal fluid leak)?
 CSF leak (Cerebrospinal fluid leak)

The loss of CSF causes the antecedently cushiony brain to sag within the os, which ends in an exceedingly headache. Loss of fluid additionally causes a lowering of pressure inside the os, a condition referred to as intracranial cardiovascular disease.

CSF leaks will occur within the brain (cranial CSF leak) or at any purpose on the vertebral column (spinal CSF leak).

Cerebrospinal fluid (CSF) leaks area units, a rare event. Researchers estimate that they occur in about five in each hundred,000 people. However, they additionally believe that this can be AN underestimate of which variety of individuals affected remains unknown. they're principally found in individuals in their 30s and 40s. CSF leaks are ordinarily misdiagnosed as migraines, alternative headache disorders or inflammation.

  1. Nervous system

Medical terms

  • Cerebrospinal fluid (CSF) surrounds your brain and neural structure and provides a cushion to safeguard them from injury. The neural structure and CSF area unit encircled by 3 layers of membranes. A CSF leak happens once there's a hole or tear within the outermost layer of those membranes (dura mater), that permits a number of the fluid to flee.

  • There are 2 distinct varieties of CSF leaks with totally different symptoms, causes and coverings. These area unit spinal CSF leaks and bone CSF leaks. A spinal CSF leak happens anywhere within the spine. A bone CSF leak happens within the os.

  • The most common symptom of a spinal CSF leak may be a headache, whereas a bone CSF leak causes symptoms like clear fluid leaking from the nose or ear. Some CSF leaks could heal with conservative treatments like bed rest. several CSF leaks would like a blood patch to hide the opening or surgery to repair the leak.

  • Cerebrospinal fluid (CSF) is the clear liquid that circulates around the brain and spinal cord It acts as a cushion keeping these areas in position inside the skull and preventing them from moving back and forth In some cases a person may develop an opening between the brain or spinal cord and the surrounding membranes (meninges) This allows CSF to leak into places where it normally doesn't go in healthy people such as the space between the brain's surface and its covering membrane (the dura mater)

Cerebrospinal fluid (CSF) leaks can be life-threatening conditions that only a handful of doctors have ever seen When CSF leaks the space between the brain and skull is filled with spinal fluid rather than normal CSF This causes pressure to increase in the brain and damages nerves and surrounding tissues Symptoms include headaches nausea vomiting or an eye that does not point in the same direction as the other one for several days In many cases a diagnosis is unclear because of misreporting by patients who may believe they are suffering from migraines or tension headaches when they aren’t

Symptoms CSF leak (Cerebrospinal fluid leak)

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 CSF leak (Cerebrospinal fluid leak)

Many cases of cerebrospinal fluid (CSF) leak have no known causes. This is called a spontaneous CSF leak. The following are other possible common 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).

Risk factors CSF leak (Cerebrospinal fluid leak)

Risk factors for spinal CSF leaks include:

  • Having a previous surgery or procedure on or around the spine

  • Connective tissue disorders such as Marfan syndrome or Ehlers-Danlos syndrome

Risk factors for cranial CSF leaks include:

  • Having a previous surgery on or around the skull

  • Obesity

  • Obstructive sleep apnea

  • Head trauma

  • Tumor at the skull base

  • Abnormalities of the skull base or inner ear

Complications CSF leak (Cerebrospinal fluid leak)

Possible complications of a cranial CSF leak that is left untreated include meningitis and air entering the spaces surrounding the brain (tension pneumocephalus).

Can a cranial CSF leak heal on its own?

Cranial CSF leaks are often related to traumatic events Although these issues can be alarming many heal on their own without intervention — especially if treatment is delayed Surgery which may include a craniotomy for placement of a dura graft or patching the hole with tissue from another area of the body is usually needed only when symptoms persist and interfere with daily activities.

Is a CSF leak life-threatening?

CSF leaks are not always serious A CSF leak is dangerous only if it causes the pressure inside your skull to drop below normal which can lead to a host of symptoms including headaches nausea and vomiting muscle weakness and seizures If you experience any of these symptoms see a doctor immediately He or she might order an MRI with myelography to locate the exact location of your spinal fluid leak.

How long can a CSF leak go untreated?

Allowing a cerebrospinal fluid leak to go untreated can lead to serious complications A small amount of flowing CSF often has no harmful effects but if the leak is not repaired eventually enough fluid will accumulate to put pressure on the brain causing pain and increasing the risk for meningitis If a patient does develop meningitis following a small CSF leak it should be treated promptly with antibiotics; however there is no way to treat the underlying cause of the leak.

What kind of doctor treats CSF leak?

Doctors who treat CSF leaks usually specialize in the treatment of spine-related disorders These doctors are known as neurosurgeons for spine surgeons They may have fellowships in neurotrauma spinal trauma or functional neurosurgery that allow them to treat CSF leaks and other associated conditions.

How can I increase my CSF flow?

1. C-Shape: The “C” in the first step of this method stands for the curve that you should have from your ribs to your hips To increase the flow of CSF draw in your stomach when you breathe to fill up more space between the ribs and pelvis Hold that spot until you exhale Repeat for about 40 seconds then break for 30 seconds Do three sets everyday after lunch 2. Lift Heavy Objects: Research shows that working out with heavy objects can enlarge the opening between the CSF which helps fluid move through it more quickly and easily leading to clear eyes.

Does CSF leak make you tired?

Chronic fatigue syndrome is a condition that causes extreme and persistent fatigue that lasts six months or longer It affects about 1 in 100 adults and 2 percent of children according to the Centers for Disease Control and Prevention The cause of chronic fatigue syndrome has not been identified although many researchers believe it's related to immune system dysfunction or problems with how energy is produced in the cells of the body CFS can also be brought on by stress depression Lyme disease or multiple sclerosis drugs.

Diagnosis CSF leak (Cerebrospinal fluid leak)

Diagnosing a CSF leak includes Associate in Nursing analysis of the nasal fluid for a macromolecule known as beta-2 siderophilin that is most solely found in humor. CT and tomography scans might also be needed to work out the placement and severity of the outflow.

Two diagnostic tests might also be performed to help within the identification of the CSF leak: a garland CT cisternogram and a pledget study.

A pledget study involves putting little cotton pads (called "pledgets") into the nose. This check is employed to verify the presence of a CSF leak, though it cannot verify the precise location of the leak. To work out the precise location of the leak, a CT cisternogram would be performed. A CT cisternogram involves employing a distinction injected into the liquid body substance through a lumbar puncture so acting CT scans. This check identifies the precise location of the CSF leak and therefore the pathway of the voidance into the nose.

Spinal CSF leak

Your doctor can doubtless begin along with your medical record and physical communication. the flexibleness of your joints conjointly is also checked.


Tests to diagnose a spinal CSF leak might include:

  • MRI with gadolinium. This imaging test uses a contrast agent, gadolinium, to better highlight abnormalities in the brain or spine that result from a CSF leak.

  • Radioisotope cisternography. This check involves mensuration the CSF pressure then injecting a chemical into the area close to the funiculus. Then, pictures of square measure|the world|the realm} are taken many times at intervals a 24-hour amount. These pictures track the flow of CSF, which is able to be abnormal if there's a full of life spinal CSF leak. 

  • Myelography. This check is taken into account the gold normal for diagnosis and locating CSF leaks. It uses digital subtraction radioscopy, a CT or magnetic resonance imaging scan, and a distinction dye to find CSF leaks. It provides the foremost precise location of a CSF leak and helps to work out the foremost acceptable treatment set up. 

  • Spinal tap (lumbar puncture). This test involves placing a needle in the spinal column to measure the pressure of CSF inside the spinal column, though pressure is normal in more than half of patients with spinal CSF leaks.

Cranial CSF leak

Your doctor can doubtless begin along with your case history and a physical test, together with shut analysis of your nose and ears. you'll be asked to lean forward to see for any nasal discharge, which can be collected and sent to a research laboratory for testing.


Tests to diagnose a bone CSF leak could include:

  • MRI with gadolinium. This imaging test uses a contrast agent, gadolinium, to better highlight abnormalities in the brain to locate the source of a CSF leak.

  • Tympanometry. Your middle ear fluid may be tested to check for CSF.

  • CT myelography. This check is taken into account the gold normal for identification and locating CSF leaks. It uses a CT scan and a distinction dye to find CSF leaks anywhere within the os base. It provides the foremost precise location of a CSF leak and helps to see the foremost acceptable treatment set up. high-resolution CT (HRCT), that provides pictures in even bigger detail, additionally is also used. 

Treatment CSF leak (Cerebrospinal fluid leak)

Some CSF leaks improve with bed rest alone. different CSF leaks may have treatment.


Treatments for spinal CSF leaks might include:

  • Epidural blood patch. This treatment involves taking a sample of your own blood, then injecting it into the epithelial duct. The blood cells create a clot that creates a patch to hide the realm wherever the CSF is unseaworthy. 

  • 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 would like surgery, although surgery is simply performed if the opposite treatment choices do not work and also the precise web site of the leak is understood. There are many kinds of surgical treatments that repair CSF leaks. Surgery could involve repairing the CSF leak with stitches or grafts made of patches of muscle or fat. 

  • Trans-venous embolization. This is a brand new minimally invasive, catheter-based treatment for CSF-venous fistulas solely that involves gluing shut the fistula from within the offender vein.
    Some os CSF leaks, like 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.

Preparing for your appointment

After discussing your symptoms along with your general practitioner, he or she may refer you to a doctor trained in brain and spine conditions (neurologist, surgeon, ENT) for more analysis.


Here's some data to assist you make preparations for your appointment.

What you can do

Make a list of:

  • Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began

  • Key personal information, including major stresses or recent life changes

  • All medications, vitamins or other supplements you take, including doses

  • Questions to ask your doctor
    Bring with you to the appointment recent check results and scans of your brain and spine. Take a friend or friend on, if attainable, to assist you keep in mind the data you receive. 

For CSF leaks, questions to ask your doctor include:

  • What is likely causing my symptoms or condition?

  • What tests do I need?

  • Is my condition likely temporary or chronic?

  • What is the best course of action?

  • Would losing weight help my condition?

  • I have these other health conditions. How can I best manage them together?

  • Are there restrictions I need to follow?

  • Should I see a specialist?

  • Are there brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

  • Have your symptoms been continuous or occasional?

  • How severe are your symptoms?

  • What, if anything, seems to improve your symptoms?

  • What, if anything, appears to worsen your symptoms?

General summary

  1. When a CSF leak occurs patients must take it easy A reversible deficit may occur in which swelling of the spinal cord brings pressure on brain cells and pressure is relieved by lying down A patient with this type of symptom should lie down as much as possible Another CSF leak symptom is dizziness if the fluid accumulates in front of the nasal cavity or behind the eye sockets Patients should keep their head higher than they would normally while sitting upright in bed or a chair to relieve symptoms

  2. Cystic fibrosis is a genetic disorder that affects the lungs and digestive system of about 30,000 people worldwide Affected individuals are missing a protein that regulates the movement of salt and other fluids in cells lining their airways and intestines As a result these cells produce excessive amounts of thick mucus which clogs the airways This impairs lung function and makes infections more likely to occur People with cystic fibrosis also have problems absorbing nutrients from food because they also have an inflammation-related defect in their pancreas Cystic fibrosis can be fatal if patients' lungs become severely infected or fail to.

CSF leak (Cerebrospinal fluid leak): Causes-Symptoms-Diagnosis-Treatment

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