A cerebrospinal fluid (CSF) leak occurs when the fluid that surrounds and cushions the brain and spinal cord escapes through a hole or tear in the dura mater—the protective membrane around the brain and spinal cord.

This leak can happen in the spinal canal or in the skull base, and it results in a drop in CSF pressure, which can cause a wide range of neurological symptoms.

Though rare, untreated CSF leaks can lead to meningitis, brain sagging, or other serious complications.

⚠️ Common Cerebrospinal Fluid Leak Symptoms

CSF leak symptoms vary depending on the location of the leak » spinal vs. cranial. However, the most common symptom across both is a positional headache, which worsens when standing or sitting and improves when lying down.

☝️ Key Symptoms Include:

» Orthostatic headache (headache that improves when lying down)

» Clear, watery drainage from the nose or ear (if cranial leak)

» Neck stiffness

» Tinnitus (ringing in the ears)

» Blurred or double vision

» Nausea and vomiting

» Dizziness or vertigo

» Cognitive issues or difficulty concentrating

» Photophobia (sensitivity to light)

» Balance problems

» Facial numbness or weakness

🧪 Causes of CSF Leak

A CSF leak can be spontaneous, traumatic, or post-surgical. Understanding the cause helps guide treatment.

🔹 Spontaneous CSF Leaks:

Occur without obvious injury or trauma. Often linked to:

» Connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos)

» High intracranial pressure

» Congenital skull base defects

🔹 Traumatic CSF Leaks:

Caused by:

» Head injuries or fractures at the base of the skull

» Spinal trauma

» Whiplash or violent motion of the head

🔹 Post-surgical or Iatrogenic Leaks:

Occur after medical procedures such as:

» Lumbar puncture (spinal tap)

» Spinal or brain surgery

» Epidural anesthesia

🔍 How Is a CSF Leak Diagnosed?

Doctors use a combination of clinical symptoms, imaging, and lab tests to confirm a diagnosis:

🩺 1. Beta-2 transferrin test

A lab test that confirms CSF fluid in nasal or ear discharge » highly specific.

🧠 2. MRI or CT myelography

These imaging tests help locate the exact site of the leak in the spine or skull.

📷 3. High-resolution CT scan

Useful for detecting bone defects at the skull base.

🔦 4. Intrathecal fluorescein dye

Sometimes used during surgery to visually detect leaks.

💉 Treatment for Cerebrospinal Fluid Leak

Treatment depends on the location and severity of the leak. Some mild leaks may heal on their own, while others require medical intervention.

🔹 Conservative (Non-Surgical) Management:

» Bed rest (lying flat for extended periods)

» Increased fluid intake (including caffeine)

» Avoiding straining, bending, or lifting

» Caffeine IV for low-pressure headache

» Pain relief medications

🔹 Epidural Blood Patch:

» Common for spinal CSF leaks

» A small amount of your blood is injected into the spinal area to “patch” the leak

» Often very effective and may be repeated if necessary

🔹 Surgery:

» Required if the leak doesn’t heal or is caused by trauma or structural defect

» Neurosurgeons or ENT specialists may close the hole using fat grafts, tissue, or synthetic material

» Skull base leaks may be repaired via endoscopic nasal surgery