Cerebrospinal Fluid Leak

Cerebrospinal fluid (CSF) is a colourless, clear fluid that circulates in the ventricles of the brain and around the surface of the spinal cord and brain. Depending on where the damage is in the skull bone, the fluid can leak out either through the nose or ear. A CSF leak happens due to a tear or hole in the dura which is the outermost layer of the three membranes covering the spinal cord and the brain. A hole or tear in the dura can occur due to a head injury, sinus surgery, or brain surgery. Lumbar puncture also known as a spinal anaesthesia or spinal tap can also lead to CSF leaks. Sometimes there can be a sudden CSF leakage for no known reasons. You should reach out to the best doctor as soon as you experience the symptoms of a CSK leak. Your doctor will suggest the best treatment option as per your condition. Your doctor will conduct a physical examination in order to diagnose CSK leaks. The treatment options that are available for treating a cerebrospinal fluid (CSF) leak are medical and surgical treatment. The surgical treatment option is recommended by the doctor when conservative treatment does not solve the purpose. The most serious complication associated with CSF leak is meningitis. Meningitis is an inflammation of the spinal cord and brain membranes. This problem can be life-threatening sometimes. The person with meningitis should seek immediate medical help as it is a serious complication. Another complication of CSF leak is intracranial infections. Intracranial hypotension is also a complication of the cerebrospinal fluid leak.

Symptoms

Check out the various common symptoms or signs of CSF leaks:

-  People generally experience the drainage of fluid from an ear or one side of the nose. The drainage can increase due to straining or tilting the head ahead.

-  Hearing loss, vision changes, and headache are some of the other symptoms of CSF leaks.

-  CSF leaks can also lead to inflammation of the spinal cord and brain membranes known as meningitis.

-  Tinnitus is also one of the signs of CSF leaks.

Causes of Cerebrospinal Fluid Leak

A CSF leak happens when a hole or tear is formed in the membrane that surrounds the spinal cord and brain. Due to this cerebrospinal fluid which bathes and supports the central nervous system seeps out. Check out various possible causes of CSF leaks:

-  Certain spinal, brain, or head injuries can lead to CSF leaks.

-  Major trauma including spinal and head injuries can cause CSF leaks.

-  Minor trauma including twist, a violent cough, or a sneeze is the possible cause of a CSF leak.

-  Underlying intracranial hypertension if left untreated can be a cause of a CSF leak.

-  Underlying connective tissue disorders can lead to a CSF leak including hypermobility and Ehlers-Danlos syndrome.

-  In epidural anaesthesia, tubes are inserted that can cause CSF leaks.

-  In hydrocephalus, shunts are inserted that can lead to CSF leaks.

-  Pain medicines, spinal taps, and lumbar punctures are some of the other causes of CSF leaks.

How Cerebrospinal Fluid Leak is diagnosed?

You should reach out to the best doctor as soon as you experience the symptoms of CSF leaks. Your doctor will conduct a physical examination. Your nose will be examined with the help of an endoscope. You may be asked by your doctor to lean ahead in order to check if the drainage increases with this. In order to be sure that it is cerebrospinal fluid, your doctor may send the sample of your drainage to a laboratory for testing. To evaluate the defects of the skull bone, your doctor may ask to get the imaging studies done including MRIs or CT scans. Further tests may be conducted if required to get a help in the diagnosis of the CSF leak including a pledget study and a coronal CT cisternogram. In a pledget study, small cotton pads known as pledgets are placed into the nose. This test does not help to find out the exact location of the CSF leak but it helps to confirm whether there is a CSF leak or not. In order to find out the exact location of the leak, your doctor will conduct a coronal CT cisternogram. In a coronal CT cisternogram, a contrast is injected through a spinal tap into the spinal fluid and then CT scans are performed. This diagnostic test is quite helpful as it is used to identify the exact location of the CSF leaks and the drainage pathway into the nose.

Treatment of Cerebrospinal Fluid Leak

Your doctor will suggest the best treatment option as per your requirement. The problem of a CSF leak can be treated either medically or surgically. In head trauma or spontaneous CSF leak cases, conservative treatment is generally recommended by the doctor. In this treatment, the bed rest is required for 1-2 weeks. The affected people are encouraged to avoid heavy lifting, sneezing, and coughing. Stool softeners are used to avoid straining. Your doctor may recommend you to place a lumbar drain in the low back to reduce the CSF fluid pressure near the portion of the leak. This is generally done to allow this portion to heal. When conservative treatment fails then doctor recommend a surgical treatment option for a CSF leak. It can be done either with the help of an external incision or endoscopy. During surgery, the surgeon places graft material to close the skull base hole. Many types of graft material are available such as tissue taken from other portions of the body or synthetic material. At the end of the surgery, nasal packing is generally placed. After a week, it is removed.

To decrease pressure and allow the CSF leak to resolve on its own, you should follow various steps:

-  You should stay in your bed with the head raised on the pillow.

-  You should avoid coughing.

-  You should avoid vomiting.

-  You should not blow your nose.

-  You should avoid straining when you have a bowel movement.

Complications

Many complications are associated with CSF leaks. Check out the various serious problems related to CSF leaks:

- Meningitis: Meningitis is the most severe and feared problem-related to a CSF leak. Meningitis is an inflammation of the spinal cord and brain membranes. The common causes of meningitis are bacterial and viral infections. Bacterial meningitis occurs due to Haemophilus influenza and Streptococcus pneumoniae. Bacterial meningitis can get worse if not diagnosed and treated properly on time. Many types of bacterial meningitis can be treated with the help of a vaccine. The vaccines are available for meningococcal meningitis that occurs due to Neisseria meningitidis. Meningococcal meningitis is a serious bacterial infection but it occurs rarely. A stiff neck, fever, and headache are some of the symptoms that occur due to swelling from meningitis. Sometimes it can be life-threatening. It is a serious problem so it is important that you reach out to a doctor for medical help as soon as you experience the symptoms of meningitis.

- Intracranial hypotension: Intracranial hypotension is a complication of the spontaneous cerebrospinal fluid (CSF) leak. In this condition, there is a negative pressure within the cavity of the brain. This condition can occur due to a defect in the dura, spinal surgery, spinal trauma, spinal tap, and shunt procedure for hydrocephalus. Nausea, difficulty with concentration, vomiting, severe headache, and double vision are some of the symptoms of intracranial hypotension. This condition is also known as craniospinal hypotension. You should visit a doctor as soon as you experience the signs of intracranial hypotension. The results are excellent when a doctor is able to understand the exact cause of intracranial hypotension.

- Intracranial infections: Another complication of CSF leak is intracranial infections. The first symptom that is generally experienced by the people due to intracranial infections is a headache.

Conclusion

Cerebrospinal fluid can leak out through the ear or nose. It is a colourless, clear fluid that circulates in the ventricles of the brain and around the surface of the spinal cord and brain. When there is a tear or hole in the outermost layer of the three membranes covering the spinal cord and the brain that is dura then it can lead to a CSF leak. A leakage from an ear or one side of the nose, hearing loss, vision changes, headache, inflammation of the spinal cord and brain membranes (meningitis), and tinnitus are some of the possible symptoms of CSF leaks. Certain injuries to the spinal, brain, or head can be a cause of a CSF leak. Pain medicines, spinal taps, untreated underlying intracranial hypertension, underlying connective tissue disorders and lumbar punctures are some of the causes of a CSF leak. There is a possibility that there can be a sudden CSF leakage for no known reasons.

It is important that you visit a doctor as soon as you experience the symptoms or signs of a CSF leak. Your doctor will conduct a physical examination in order to diagnose. An endoscope will be used to examine the nose. Your doctor may ask you to lean ahead in order to check that this increases your drainage or not. To confirm the diagnosis your doctor may send the sample of your drainage to a laboratory for the testing purpose. MRIs or CT scans may be recommended by your doctor to evaluate the defects of the skull bone. Your doctor will recommend you the best treatment option as per your condition. This problem can be treated either medically or surgically. The cases of head trauma or spontaneous CSF leak are generally treated with the help of conservative treatment. The surgical treatment option is recommended when conservative treatment does not work or fails.

In conservative treatment, 1-2 weeks bed rest is recommended. Patients should avoid heavy lifting, sneezing, and coughing. To avoid straining, stool softeners are used. The surgery can be done either with the help of an external incision or endoscopy. You should avoid coughing, vomiting, blowing the nose and straining to decrease pressure and allow the CSF leak to resolve on its own. You should stay on your bed. You should raise your head with the help of a pillow when you are on your bed. Many complications are associated with a CSF leak. The most severe complication of the CSF leak is meningitis. In meningitis, the membranes of the spinal cord and brain inflame due to an infection. Sometimes meningitis can even threaten your life. A headache, fever and a stiff neck are some of the signs of meningitis. Some types of meningitis can be prevented with the help of vaccines. Intracranial infection is another complication of the CSF leak. Due to intracranial infections, people may experience a headache. Intracranial hypotension is also a complication of the CSF fluid.

If you are looking for the answers to various questions including:

-  What is a cerebrospinal fluid (CSF) leak?

-  What are the signs or symptoms of a cerebrospinal fluid (CSF) leak?

-  What are the causes of a cerebrospinal fluid (CSF) leak?

-  How is a cerebrospinal fluid (CSF) leak diagnosed?

-  How is a cerebrospinal fluid (CSF) leak treated?

-  What are the various complications associated with a cerebrospinal fluid (CSF) leak?

Then you are in the right place. Please refer to the above-mentioned information in order to get answers to all your questions.

Last updated on : 14-09-2018

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