Cerebrospinal fluid (CSF) is a clear liquid that surrounds the brain and spinal cord. Its function is to supply nutrients to these areas and to cushion the brain within the skull.

The brain is covered in thin layers of tissue collectively called the dura mater, and CSF can escape through a tear in this tissue. The fluid may then leak from the nose or ears or into other parts of the body.

Also, CFS in the spine can leak into muscles and connective tissue surrounding the spinal column.

A CSF leak is a serious issue that can cause complications such as headaches, meningitis, and seizures.

This article describes the causes and symptoms of a CSF leak. Information technology also looks into how doctors diagnose and care for the outcome and what to expect during recovery.

a person experiencing a headache and tinnitus because of a CSF leak Share on Pinterest
A person with a CSF leak may experience an upright headache, tinnitus, and hearing loss.

According to the Spinal CSF Leak Foundation, the about mutual symptom of a CSF leak is an upright headache — a headache that worsens when the caput is in an upright position, as when a person is sitting or standing. These headaches usually improve when the person lies downwardly.

Sometimes, the position of the head does not directly affect the severity of the headache. Instead, a person may experience a headache that worsens throughout the 24-hour interval.

An private with a CSF leak may as well notice clear, watery fluid draining from their olfactory organ or ears when they move their head, especially when bending forward. CSF may as well drain downwardly the back of the throat. People draw the taste as salty and metallic.

Other symptoms of a CSF leak include:

  • tinnitus, or ringing in the ears
  • hearing loss
  • changes in vision

In adults, upward to 90% of all CSF leaks result from caput injuries.

Edgeless force head injuries can fracture bones in the face or the temporal bones on either side of the skull. These fractures can also tear the dura mater, causing a CSF leak.

Other causes of a CSF leak — in the skull or spine — include:

  • infection
  • an epidural injection
  • an coldhearted injection
  • a lumbar puncture
  • brain tumors
  • surgery on or effectually the base of the skull or spine
  • structural abnormalities of the skull that accept been present from birth

A doctor can utilize a number of tests to diagnose a CSF leak.

1 test involves placing a sample of what the doctor suspects to be CSF belch on a piece of filter newspaper. Once in contact with the paper, any CSF will divide from any blood or fungus. The event will form ii singled-out rings, called a "target" or "double ring" sign.

A healthcare professional can often identify CSF just by looking at a sample on a handkerchief or piece of gauze. Unlike fungus, which is thick and pasty, CSF is clear and watery.

Compared with mucus, CSF also has a loftier concentration of glucose. Checking the glucose levels in nasal discharge tin can aid decide whether it contains CSF. Any sample of discharge that contains CSF can point a leak.

If a doctor suspects a CSF leak, they may lodge a CT or MRI scan to help confirm the diagnosis and locate the leak.

Treatment for a CSF leak depends on its severity and the cause. Some leaks answer to bourgeois treatment, while others require more than invasive approaches.

Conservative treatments

Bourgeois treatments mainly focus on managing symptoms. These treatments may include:

  • bed residual
  • staying hydrated
  • taking over-the-counter or prescription hurting relief medication
  • receiving intravenous caffeine infusions

Invasive treatments

A CSF leak that does not respond to conservative handling may crave more invasive approaches, such as those below.

An epidural blood patch

An epidural blood patch is a surgical procedure that involves using a person'southward own claret to patch tears in the dura mater.

During the procedure, the surgeon draws v–25 milliliters of the person's blood, then injects it into a space just exterior of the tear in the dura mater.

Epidural blood patches have loftier success rates simply may non cure all types of CSF leaks.

In one 2022 report, researchers compared the success rates of epidural blood patches in 133 people with CSF leaks.

The researchers divided the participants into two groups based on the blazon of CSF leak. In one group, medical procedures had been responsible for the leaks. In the other group, there was no identified crusade.

In 90.9% of the CSF leaks resulting from medical procedures, a single blood patch successfully treated each leak. In the other group, yet, but 44.i% of the participants experienced total recovery after each having received a unmarried patch. The rest of the grouping required additional treatment.

Surgery

A doctor may recommend surgery if a person has:

  • a CSF leak that does non improve with bourgeois treatment
  • a severe CSF leak that is unlikely to heal on its own
  • blood clotting in the brain or spinal cord
  • herniated brain tissue that pushes into the ears or nose
  • meningitis

Surgery involves suturing — or stitching— any tear to prevent further CSF leakage.

The specific approach depends on the location of the tear. For example, if a tear is in dura mater at the front of the caput and causes the fluid to leak through the nose, the neurosurgeon may perform an endoscopic repair.

This is minimally invasive and involves inserting a thin, flexible tube called an endoscope through the nose, so passing tiny surgical tools through the tube to repair the tear.

If a tear causes CSF to bleed from the ears, a neurosurgeon will need to perform open surgery. This involves making an incision in the scalp.

While an endoscopic approach presents less gamble than traditional open up surgery, the two methods have similar success rates.

A 2013 review compared the success rates of endoscopic and traditional surgical treatments of CSF leaks in the front end of the skull. The review evaluated 71 studies, involving a full of 1,178 participants. The researchers plant that each method successfully treated around 90% of CSF leaks.

A person should consider seeing a doctor if they experience any of the following symptoms of a CSF leak:

  • a persistent runny nose
  • drainage from the ears
  • a headache that worsens when the head is upright

Also, anyone who experiences symptoms of a CSF leak following any of the following should seek medical attention:

  • a head injury
  • a contempo epidural
  • brain surgery
  • spinal cord surgery

Recovery depends largely on the severity of the leak and the type of treatment.

People who receive bourgeois treatment can look to stay in bed for at least 3 days. The doctor may recommend keeping the head elevated to encourage CSF drainage.

Even so, if the fluid drains too speedily, it can cause pockets of gas — called cranial aeroceles — to form inside the skull.

Other potential complications of a CSF leak include:

  • brain herniation, which involves the dislocation of brain tissue inside the skull
  • a stroke
  • a coma

When a person has undergone surgical repair, they can wait to stay in the hospital for a few days or weeks. During this time, healthcare professionals will closely monitor their recovery and bank check for signs of complications, such as:

  • abscesses
  • infections
  • meningitis

Early and accurate diagnosis of a CSF leak can atomic number 82 to better treatment outcomes. Information technology tin also help prevent complications.

If symptoms do not improve within ten days of conservative handling, or if they return, a more invasive intervention may exist necessary.

Both epidural blood patch and surgical procedures accept relatively high success rates. All the same, they may not piece of work. Fifty-fifty after surgery, some people go on to experience symptoms or inability resulting from CSF leakage.

A doctor or another healthcare professional who specializes in neurological conditions can discuss the options and recommend a class of treatment.

A CSF leak is a serious health effect. It involves this blazon of fluid escaping through a tear in the dura mater.

The symptoms of a CSF leak include fluid drainage from the ears or olfactory organ and a headache that worsens when the head is upright.

These leaks tin can result from head injuries, infections, and certain medical procedures. Although this issue may not cause alarming symptoms, it can lead to complications if the person does non receive appropriate treatment.

The right treatment varies, depending on factors specific to each person. Early bourgeois treatment usually involves bed rest and hydration. If symptoms practice non meliorate within x days, the person may require a more invasive process, such as an epidural blood patch or surgery.