CSF leak

Definition

CSF leak is an escape of the fluid that surrounds the brain and spinal cord.

Alternative Names

Causes

The dura is the membrane that surrounds the brain and spinal cord and contains the cerebrospinal fluid (CSF). A tear in the dura may occur without cause, after certain head, brain, or spinal surgeries, or after a head injury.

CSF leak can also be caused by a lumbar puncture (spinal tap) or by placement of tubes used for epidural anesthesia or pain medications.

Symptoms

Symptoms usually include a headache that is worse with sitting up and improves when you lay down. Leakage of CSF from a tear of the dura in the head can also cause a runny nose.

Exams and Tests

Diagnosis is usually based on the person's history of injury, surgery, or lumbar puncture. An MRI may be done to try to confirm the diagnosis.

Treatment

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.

Headache may be treated with pain relievers and fluids. If the headache persists longer than a week after a lumbar puncture, a procedure may be done to block the hole that may be leaking fluid. In most cases, this makes symptoms go away.

If symptoms of infection occur (fever, chills, change in mental status), antibiotic therapy is required.

Outlook (Prognosis)

Prognosis is usually good depending on the cause. Most cases heal spontaneously with no lasting symptoms. If the leak is due to head trauma or surgery, complications may be caused by underlying conditions. Careful attention should be paid to the possibility of infection, which can also cause serious complications.

Possible Complications

Complications may occur if the underlying cause is surgery or trauma. Infections can cause serious complications such as swelling of the brain. CSF leak due to a lumbar puncture usually resolves satisfactorily.

When to Contact a Medical Professional

Call your health care provider if you have symptoms of a headache which gets worse when you sit up, particularly if you have recently had head injury, surgery, or childbirth involving epidural anesthesia.

Prevention

Measures such as wearing a helmet when riding a bicycle or motorcycle can help prevent head injuries that can lead to CSF leak.