A CSF leak is an escape of the fluid that surrounds the brain and spinal cord.
Causes, incidence, and risk factors
Any tear or hole in the membrane that surrounds the brain and spinal cord (dura) can allow the fluid that surrounds those organs to leak.
This fluid is called the cerebrospinal fluid (CSF). When it leaks out, the pressure around the brain and spinal cord drops.
Causes of leakage through the dura include:
Certain head, brain, or spinal surgeries
Placement of tubes for epidural anesthesia or pain medications
Spinal tap (
Sometimes, no cause can be found. This is called a spontaneous CSF leak.
Symptoms may include:
A headache that is worse when you sit up and improves when you lie down. It may be associated with:
- Light sensitivity
- Neck stiffness
Drainage of CSF from the ear (rarely)
Drainage of CSF from the nose (rarely)
Signs and tests
Diagnosis is usually based on your history of injury, surgery, or lumbar puncture.
Tests may include:
CT scan of the headwith contrast dye
MRI of the heador spine
Radioisotope test of the CSF to track the leakage
Depending on the cause of the leak, many cases go away on their own after a few days. Complete bed rest for several days is usually recommended. Drinking increased fluids, especially drinks with caffeine, can help slow or stop the leak and may help with headache pain.
Headache may be treated with
Symptoms of infection (
The outlook is usually good depending on the cause. Most cases heal by themselves with no lasting symptoms.
If the CSF leak keeps coming back, high pressure of the CSF (hydrocephalus) might be the cause and should be treated.
Calling your health care provider
Call your health care provider if:
You have a headache that gets worse when you sit up, especially if you have recently had a head injury, surgery, or childbirth involving epidural anesthesia.
You have a moderate head injury, and then develop a headache that is worse when you sit up, or you have a thin, clear fluid draining from your nose or ear.
Most CSF leaks are a complication of a spinal tap or surgery. The health care provider should use the smallest needle possible when doing a spinal tap.