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 Cerebrospinal Fluid Leak occurs when there is a hole or tear in the outer layer of these membranes (dura mater) that 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 CSF leak in the spine can occur anywhere in the spine. 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 treatment such as bed rest. Many CSF leaks require a blood patch to cover the hole or surgery to repair the leak.

Symptoms of Cerebrospinal Fluid Leak:

Symptoms differ between spinal and cranial CSF leaks.

CSF leaks:

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

• Cause pain in the back of the head
• Get better lying down
• Worse on getting up
• May start or worsen with exertion (such as coughing or straining)
• Rarely start suddenly (“stormy” type headaches)

Other symptoms of spinal CSF leak may include:

• Neck or shoulder pain
• Ringing in the ears (tinnitus)
• Hearing changes
• Dizziness
• Nausea or vomiting
• Vision changes
• Changes in cognition or behavior
• Cranial CSF leaks

Symptoms of a CSF leak may include:

• Clear, watery drainage from the nose or ear (on one side)
• Hearing loss
• Metallic taste in the mouth
• Meningitis

Causes Cerebrospinal Fluid Leak:

Spinal CSF leaks can be caused by:

• Lumbar puncture (spinal tap)
• Spinal epidural for pain relief, such as during labor and delivery
• Head or spine injury
• Bone spurs along the spine
• Abnormalities of the dura mater around nerve roots in the spine
• Abnormal connection between dura mater and veins (CSF-venous fistula)
• Previous spinal surgery

Cranial CSF leaks can be caused by:

• Head injury
• Increased pressure in the brain
• Malfunctioning shunt
• Malformation of the inner ear

Sometimes CSF leaks develop after very small events:

• Sneezing
• Cough
• Straining to have a bowel movement
• Lifting heavy objects
• Falling
• Stretching
• Exercises
• Sometimes a CSF leak has no known cause (spontaneous CSF leak).

To consult a Neurologist at Sparsh DIagnostic Centre, call our helpline number 9830117733.

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