Cerebrospinal Fluid Leak

 

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Cerebrospinal Fluid Leak is an abnormal leak of cerebrospinal fluid (CSF) caused by a tear in the membrane covering the brain. CSF is a clear colorless fluid that cushions the brain during trauma and provides nourishment for it.  CSF is located within spaces of the brain called ventricles and subarachnoid spaces.  However, when the membrane surrounding the brain (called the dura) weakens or tears, CSF can leak. Cerebrospinal Fluid Leak occurs in 5 out of 100,000 people.  

 

CSF leak may be caused by severe traumatic injury to the brain, a ruptured/leaking encephalocele, or recent cranial/spinal surgery.  People with this condition may commonly experience headaches, light sensitivity, neck stiffness.  The leak may manifest as a intermittent or persistent dripping of clear fluid from the nose, or persistent ‘salty taste’ in the back of the throat.  More severe symptoms include hearing loss, meningitis, and coma. Several types of studies may be used to diagnose and locate a CSF leak, including MRI, CT scan with intrathecal contrast, nuclear tracer studies, and direct endonasal examination by an ENT surgeon.

 

In many cases, cerebrospinal fluid leaks may heal with bed rest and hydration. A blood patch can be used to seal the tear in the dura if the CSF leak is in the spine. For persistent cases, especially cranial CSF leaks, surgical intervention may be needed.  This often involved endoscopic endonasal repair performed through the nostrils with an ENT and neurosurgeon together.

 

 

References


Schievink, Wouter. “Spontaneous Spinal Cerebrospinal Fluid Leaks and Intracranial Hypotension,” The Journal of the American Medical Association. Volume 295, Issue 19, May 2006, Pages 2286-2296

 

Raine, Christopher. Diagnosis and Management of Otologic Cerebrospinal Fluid Leak, Otolaryngologic Clinics of North America, Volume 38, Issue 4, August 2005, Pages 583-595,

 

Eseosa Ighodaro and Justin F. Fraser, MD