What is a Cerebrospinal Fluid (CSF) Leak?
What is a Cerebrospinal Fluid (CSF) Leak?A cerebrospinal fluid (CSF) leak occurs when fluid seeps out of the brain and spinal cord region from a tear in the outer layer closest to the skull. This outer membrane, called the dura, contains cerebrospinal fluid, a clear liquid that acts as a protective fluid cushion around the brain and spinal cord. This fluid regulates the temperature of the central nervous system, maintains blood supply to the brain, and is part of the structural support of both the brain and spine.
CSF leaks are considered a rare but serious condition. It is important to be aware of cerebrospinal leak symptoms and get care promptly to avoid complications, such as reduced blood supply to the brain and increased risk of developing a meningitis infection.
Types of Cerebrospinal Fluid Leaks
TypesThere are two different types of spinal fluid leaks, which are classified based on the location of the tear. The two types, spinal cerebrospinal fluid leak and cranial cerebrospinal fluid leak, have distinct causes and treatments.
- Spinal cerebrospinal fluid leak: A leak located in the spinal column is often caused by trauma, surgery, or a diagnostic procedure. Common symptoms of a spinal CSF leak are a headache that worsens when standing, nausea, and vomiting. Fluid, bed rest, and anti-inflammatory medications often relieve symptoms.
- Cranial cerebrospinal fluid leak: A leak that occurs in the skull, or cranium, causes symptoms such as chronic headaches or a watery, salty discharge from the nose or ear, generally from one side of the body. Cranial CSF leaks are most often caused by trauma and may be treated with medical intervention or surgery, depending on the severity and location of the tear.
Signs & Symptoms of a CSF Leak
SymptomsCranial and spinal CSF leaks have different signs and symptoms.
Typical symptoms of a spinal CFS leak include:
- Headache that worsens when standing or sitting up
- Pain in the back of the head
Other common symptoms of a spinal CSF leak include:
- Nausea and vomiting
- Imbalance or dizziness
- Pain, numbness, or stiffness in the neck and shoulders
- Changes in vision and hearing, including tinnitus
- Sensitivity to light and sound
- Brain fog, or trouble concentrating and thinking
Symptoms of a cranial CFS leak include:
- Water discharge from the nose or ear (often on just one side)
- Hearing loss
- Headache
- Neck pain
- Stiffness
At NewYork-Presbyterian, our cerebrospinal leak specialists will provide comprehensive care and treatment of symptoms, carefully monitoring your condition.
Long-term side effects of CSF leaks
Cerebrospinal fluid leaks are a rare but serious condition that may lead to long-term side effects or health complications if left untreated. Some complications of CSF leaks may be life-threatening and require medication and treatment to resolve.
Whether you’re experiencing a spinal CSF leak or a cranial CSF leak, it’s imperative to see a doctor to properly diagnose and manage the condition.
Long-term health effects may include:
- CNS infection, called meningitis
- Low-grade headache
- Neck stiffness
- Tinnitus/Ringing in ears
- Subdural hematomas
What Causes a CSF Leak?
CausesThere are several causes of cranial and spinal CSF leaks, which may be brought on by nonsurgical trauma, surgical trauma, or even spontaneously.
A cranial CSF leak may be caused by:
- Head trauma or injury
- Tumors
- Certain surgical procedures
- Infection
- Intracranial hypertension/head pressure
Causes of spinal CSF leaks include:
- Lumber pressure/spinal tap
- Congenital birth defects
- Epidural anesthesia
- Head/spine injury
- Certain dura matter and nerve abnormalities
- Bone spurs/calcified disc herniations
Other possible causes may include:
- Whiplash
- Lifting heavy objects
- Strenuous exercise and stretching
- Coughing and sneezing
- Sudden fall
- Straining the bowels
Some cranial and spine CSF leaks may not have an identifiable cause.
Risk Factors
Risk FactorsThere are several known risk factors for cerebrospinal leaks.
Spinal CSF leaks are most often caused by a procedure called a lumbar pressure, or a spinal tap. This is performed to remove CSF surrounding the brain and spinal cord to test for certain types of infections. A spinal tap is generally a safe procedure, but it carries risks, including CSF leaks.
Other risk factors associated with cerebrospinal leaks include:
- Spinal surgery/procedures
- Brain surgery/procedures
- Head trauma
- Connective tissue disorders
- Epidural anesthesia
- Obesity
- Sleep apnea
- Sex — people assigned female at birth are more likely to experience spontaneous leaks
Complications
ComplicationsIf the condition is left untreated, complications can develop from a chronic or ongoing CSF leak. This is due to the loss of fluid cushion around the brain and spine, as well as a reduced supply of blood to the brain, which impacts its overall function.
Serious complications include:
- Meningitis is an infection in the brain that causes inflammation of the lining of the brain and spinal cord. If left untreated, the infection may cause brain damage and can be life-threatening.
- Tension pneumocephalus, a rare but serious complication, occurs when air enters the intracranial space and causes pressure. This may lead to symptoms including headache, confusion, nausea, dizziness, and vomiting.
- Subdural hematoma, which causes sagging of the brain, can tear superficial bridging veins near the surface of the brain and cause them to bleed. The accumulated blood clot can exert pressure on the brain, resulting in a surgical emergency if not identified soon enough.
Other complications may include:
Prevention
PreventionNot all CSF leaks are preventable, but it is important to understand the risk factors and activities that may increase the likelihood of injury or severe trauma to the brain or spine. Proper safety gear and equipment can also protect the head and spine from injury-related CSF leaks.
Activities that may increase the risk of injury or trauma include:
- High-impact sports, such as football
- Roller coasters
- Extreme activities/adventure sports, such as skydiving
Exercise caution in activities that jolt the body. To further reduce the risk of a CSF leak, enhanced fall protection is recommended for those with a history of connective tissue diseases, or spinal or brain surgeries.
Trust NewYork-Presbyterian Cerebrospinal Fluid Leak Care
At NewYork-Presbyterian, our expert doctors provide comprehensive cerebrospinal fluid leak care and a full range of services to manage and treat your symptoms. CSF leak treatment from our team of brain and spinal specialists can help prevent serious complications. Make an appointment with one of our spinal fluid leak care specialists today.