CSF Leak (Cerebrospinal Fluid Leak)

Your brain and spinal cord are encircled by cerebrospinal fluid (CSF), which acts as a cushion to prevent damage. Three layers of membranes surround the spinal cord and CSF. A CSF leak happens when the dura mater, the membranes' outermost layer, develops a hole or tear, allowing part of the fluid to flow out.

CSF leaks fall into two categories, each with unique signs, causes, and remedies. They include cranial and spinal CSF leaks. Anywhere along the spinal column might have a spinal CSF leak. The skull develops a CSF leak in the brain.

A headache is the primary symptom of a spinal CSF leak, but a cranial CSF leak results in symptoms like clear liquid oozing from the nose or ear. Using conservative therapies like bed rest, certain CSF leaks may get well. Many CSF leaks require surgery to stop the leak or a blood patch to seal the hole.

CSF Leak: Causes

Spinal CSF leaks might result from −

  • A spinal puncture (spinal tap)

  • A spinal epidural used to treat pain, typically during birth and delivery

  • damage to the spine or the head

  • Spine-long bone spurs

  • Abnormalities in the dura mater around the spinal nerve roots

  • Abnormal connections between the veins and the dura mater (CSF-venous fistulas)

  • Prior spinal surgery

Cranial CSF leaks may result from −

  • Head trauma

  • An increase in cerebral pressure

  • Shunt that isn't working well

  • Issues with the inner ear

Occasionally, extremely unimportant occurrences lead to CSF leaks −

  • Sneezing

  • Coughing

  • Struggling to go to the bathroom

  • Hefty things to be raised

  • Falling

  • Stretching

  • Exercise

Sometimes there is no recognized reason for a CSF leak (spontaneous CSF leak).

CSF Leak: Symptoms

The symptoms of spinal and cranial CSF leakage differ.

Leakage of spinal CSF

Headaches are the most typical sign of a spinal CSF leak. These migraines typically −

  • Back of the head discomfort that gets better while resting down

  • Increases as you stand up

  • May begin or get worse with effort (such as coughing or straining)

  • Rarely, begin abruptly ("thunderclap" headache)

Additional indications of spinal CSF leakage might be −

  • Shoulder or neck ache

  • An earache that ringers (tinnitus)

  • Hearing changes

  • Dizziness

  • Nausea or diarrhea

  • Alterations to vision

  • Alterations in behavior or cognition

  • Skull CSF leaks

Symptoms of a cranial CSF leak may include −

  • Clear, watery discharge coming from the ear or nose (on one side)

  • Loss of hearing

  • Having a metallic aftertaste

  • Meningitis

CSF Leak: Risk Factors

The following are risk factors for spinal CSF leaks −

  • Having undergone an operation or treatment on the spine or nearby

  • Connective tissue diseases like Ehlers-Danlos syndrome or Marfan syndrome

The following are risk factors for cranial CSF leaks −

  • Having undergone surgery on or around the skull before

  • Obesity

  • Obstructive snoring

  • Head injury

  • Base of the skull tumor

  • Disorders of the inner ear or the base of the skull

CSF Leak: Diagnosis

Diagnostics may differ based on the type of CSF leakage −

Leaking Spinal CSF

Your medical history and a physical exam will probably be the first things your doctor does. Your joints' flexibility could also be examined.

Diagnostics to identify a spinal CSF leak might consist of −

  • Using gadolinium in MRI. Gadolinium, a contrast agent, is used in this imaging examination to more clearly show abnormalities in the brain or spine brought on by a CSF leak.

  • Cisternography using radioisotopes. In this procedure, the CSF pressure is measured before a drug is injected into the region around the spinal cord.

  • Myelography. The gold standard for identifying and detecting CSF leaks is this test.

  • Back tap (lumbar puncture). While pressure is normal in more than half of patients with spinal CSF leaks, this test includes inserting a needle into the spinal column to evaluate the CSF pressure inside the spinal column.

Skull CSF Leak

Your medical history and a physical examination, which includes a detailed examination of your nose and ears, are probably the first things your doctor will conduct.

Diagnostics to identify a cranial CSF leak might consist of −

  • Using gadolinium in MRI. This imaging technique employs a contrast agent, gadolinium, to better highlight abnormalities in the brain to pinpoint the site of a CSF leak.

  • Tympanometry. To screen for CSF, your middle ear fluid could be examined.

  • MRI of the spine. The gold standard for identifying and detecting CSF leaks is this test. To identify CSF leaks anywhere in the skull base, a CT scan and contrast agent are used.

CSF Leak: Treatment

Your doctor may prescribe the following treatment based on the severity of the condition −

  • Patches of epidural blood. During this procedure, a little amount of your blood is drawn and then injected into the spinal canal. Blood cells coagulate to form a patch over the spot where CSF leaks by forming a clot.

  • Sealant. To seal the hole and halt the CSF leak, a specific sealant may be applied either by itself or combined with your blood in the manner previously described.

  • Surgery. Surgery is only undertaken for some CSF leaks if all other treatments fail and the exact location of the leak is known. CSF leaks can be fixed surgically using a variety of methods. Surgery may entail closing the CSF leak with sutures or fat- or muscle-graft patches.

  • Embolization of the transvenous nature. This brand-new catheter-based, minimally invasive method of treating CSF-venous fistulas solely entails sealing the fistula from within the offending vein.

CSF Leak: Prevention

More fluids, particularly those containing caffeine, can assist to decrease or halt the leak and may lessen headache discomfort. Painkillers and water can be used to treat headaches. A treatment to seal the hole that may be leaking fluid may be performed if the headache persists for more than a week following a lumbar puncture.


Because of the many aetiologies and the vague nature of the frequent presenting symptoms, such as a headache and obvious rhinorrhea, deterrence, and patient education are only partially effective. Nonetheless, there would probably be a decline in the frequency of traumatic or obesity-related CSF leaks if public health education focused on preventing trauma, such as car accidents, as well as reducing obesity.

The issue known as CSF leak affects several facets of healthcare. Every level of the care center and any professional, such as doctors, nurse practitioners, and physician assistants, may receive a patient's initial presentation. Testing CSF samples are interpreted by laboratory personnel. The correct investigations are obtained by radiologic technicians, and radiologists then evaluate such findings. Surgical technologists, interventional radiologists, and surgeons then offer conclusive operative treatment.

Pharmacists evaluate and nurses deliver prescriptions while keeping an eye on the patient's vital signs during the patient's presentation, evaluation, and treatment. Effective communication is crucial for eliminating medical mistakes and minimizing patient damage since many of these patients' hospital stays may be protracted.

Dr. Durgesh Kumar Sinha
Dr. Durgesh Kumar Sinha


Updated on: 31-Mar-2023


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