Cerebrospinal fluid (CSF) is a type of clear liquid that surrounds, protects, and cushions your brain and spinal cord from possible injuries. The fluid is held in place by the dura mater, a dense tissue that sits directly under the skull and makes up the outermost layer of the brain.
A CSF leak may occur if there’s a tear or a hole in the dura mater. There are two types of CSF leaks. A cranial CSF leak happens when the fluid leaks from the brain, often due to things such as a skull fracture. If the leak occurs at any point along the spinal cord, it’s called a spinal CSF leak.
A leak may cause the brain to sag, which can lead to headaches. CSF leaks may also lower pressure within the skull, which could cause a condition called intracranial hypotension. If it persists, it can pull the brain down and tear bridging veins, causing a subdural hematoma.
CSF leaks are rare. According to experts, they happen to about 5 in every 100,000 people. But the number could be higher. They’re more common among people in their 30s and 40s.
What Causes a CSF Leak?
In some cases, there’s no known cause of a leak. Doctors call this a spontaneous CSF leak. But there are known causes for the fluid to leak out, such as:
- Lumbar puncture (also called a spinal tap)
- History of epidurals
- Spinal catheters
- Trauma or injuries to your head, neck, or spine
- Spinal surgeries
- Epidural shot
- Transsphenoidal surgery
- Defects in the skull base, such as meningoencephaloceles
- Abnormal CSF buildup in the brain, which increases the pressure
- Untreated intracranial hypertension (high brain fluid pressure)
- Connective tissue diseases, such as Ehlers-Danlos syndrome and Marfan syndrome
- Bone spurs in the spine
What Are the Symptoms of a CSF Leak?
- Headaches that may get worse when you sit or stand up (the pain may come and go and get better when you lie down)
- Blurry or double vision, or changes in your field of vision
- Dizziness
- Ringing in your ears
- Light sensitivity
- Sound sensitivity
- Balance issues
- Neck stiffness and pain
- Nausea
- Vomiting
- Pain between the shoulder blades
- Arm pain
- Loss of smell
- Changes in mental cognition or behavior
- Clear discharge from the nose or ear
- Metallic taste in your mouth
- Seizures
Who’s More Prone to Have a CSF Leak?
People assigned female at birth are more likely to have a CSF leak, as are people who have:
- A history of surgery in and around the spine
- Obesity
- Obstructive sleep apnea or high blood pressure
- A history of head trauma
- A tumor at the skull base
- An abnormal skull base or inner ear
How Is a CSF Leak Diagnosed?
If you’ve noticed any CSF leak symptoms, tell your doctor about them right away. The doctor will first do a physical exam and take your medical history.
The physical exam may include:
- An endoscopy of your nose, where a tube with a light and camera attached to it is passed through your nose to get a clear picture of possible issues
- Your doctor may ask you to lean forward to check if you have drainage from the nose. If so, a sample is collected for a lab test.
- Ear exam to check for CSF leaks
Your doctor may also order tests to check for problems in your brain or spinal cord. These tests may include:
- CT scan
- MRI
- Myelography, an imaging procedure done on the spine
- Cisternography, an imaging procedure done on the spine and brain
If left untreated, a CSF leak may cause complications such as meningitis, which is a condition where the protective layers around the brain become inflamed. If it persists, it can pull the brain down and tear bridging veins, causing a subdural hematoma.
The hole or tear that causes the CSF leak may allow air to enter the space between the dura mater and the brain and spinal cord, causing a condition called pneumocephalus. If pressure builds up, you get tension pneumocephalus requiring emergency surgery. This usually occurs after trauma and is not spontaneous.
Sometimes, CSF leaks may be misdiagnosed as migraines, other headache conditions, or sinusitis.
How can I test for a CSF leak at home?
It isn’t possible to test for a CSF leak at home. But knowing the symptoms can help you identify the need to seek emergency help and get diagnosed and treated right away.
What Are the CSF Leak Treatment Options?
Depending on the location and cause of the CSF leak, your treatment options may vary. For the first line of treatment, your doctor will suggest:
- Bed rest for a couple of days
- Hydration
- Caffeine
If the first line of treatment doesn’t stop the leak, your doctor may suggest surgery to plug it.
Cranial CSF leak. If the leak is in the brain, surgical options to stop the leak may include nasal endoscopy. If the leak is in your ear, a microscope may also be used. To patch the tear or hole in the dura mater, your doctor may use things such as:
- Synthetic graft
- A piece of tissue from your fat, muscle, or mucosal lining in various parts of your body
- Flap of tissue
- Surgical glue
- Bony cement
If there’s too much fluid buildup in the brain, your doctor may also do a lumbar drain in the lower back to ease the pressure.
Spinal CSF leak. To stop the leak from your spinal cord, doctors may use treatments such as:
- Epidural blood patch, a treatment that injects your own blood into the spinal cord to form blood clots to stop the leak
- Fat or muscle grafts
- Stitches
What’s the Average CSF Leak Recovery Time?
Some CSF leaks heal on their own in a few days or weeks with bed rest. But recovery from surgical closure of a CSF leak can take several months. If you’ve been diagnosed and treated for a CSF leak, during your recovery period, your doctor will suggest you take precautions for four to six weeks after the treatment.
These include:
- Don’t lift anything heavier than 10 pounds.
- Avoid bending, lifting, stretching, and twisting.
- Don’t strain to have a bowel movement — use a stool softener if necessary.
- Avoid coughing and sneezing. If you need to cough or sneeze, do it with your mouth open to ease pressure.
- If the CFS is leaking from your nose, avoid blowing your nose.
- Don’t use straws.
- Keep your back straight during all movements — bend your knees and hips instead.
CSF Leak Prevention
CSF leaks are not preventable because they usually happen unpredictably. If you have an underlying condition such as a connective tissue disorder, you may limit your risk of CSF leak by managing your condition. You may also lower your risk for CSF leaks that are injury-related by taking safety precautions. Wearing safety gear can help minimize your risk by protecting you from face, head, neck, and back injuries, which are common causes of CSF leaks.
Takeaways
A CSF leak happens when the cerebrospinal fluid, the cushioning fluid around your brain and spine, seeps through a small tear caused by injury, a medical procedure, a connective tissue disorder, or an unknown cause. CSF leaks can cause headaches, dizziness, or even a clear liquid dripping from your nose or ears. Most leaks heal with bed rest and lots of fluids, but some may require surgery to patch the tear. Then, recovery may take up to a few weeks or more of rest and no activity.
FAQs About Cerebrospinal Fluid (CSF) Leaks
What are the long-term side effects of a CSF leak?
If your CSF leak is left untreated, you may be at risk for serious long-term side effects such as low-grade headache, neck stiffness, tinnitus, subdural hematoma, or even meningitis.
Is a CSF leak an emergency?
If your symptoms are severe or you experience a leak from your nose or ears, which raises your risk of infection, seek medical attention immediately. If you have a known CSF leak that is stable and experience symptoms of stroke (numbness, weakness, slurred speech) or meningitis (fever, rash, light sensitivity, neck stiffness), changes in vision or hearing, confusion, or seizures, go to the emergency room.
How do I tell if I have a CSF leak?
One symptom of a CSF leak includes a headache that gets worse when you sit up but eases when you lie down. You may also have CSF drainage from your ear or nose.
How do I treat CSF leaks at home?
Your doctor can help explain how to treat CSF leaks at home, which mainly entails bed rest for several days and lots of fluids, especially caffeine, which can help slow down the leak and help with headache pain. This usually helps your CSF leak heal. Keep an eye out for complications, including symptoms of infection, and contact your doctor.
