What Causes A Csf Leak
Experts estimate that about 90% of CSF leaks happen because of injuries. The remaining 10% happen spontaneously or for unknown reasons.
Many injuries can cause CSF leaks. These include:
- Injuries to your face, head, neck or spine. A common example of this is injuries from car crashes. The most likely injuries involve your nose, sinuses, ears, temples or the base of your skull. Twisting or severe whiplash can also cause tears that leak CSF fluid near your spinal cord.
- Penetrating injuries .
- Injuries from brain surgery.
- Injuries from ear, nose and throat medical procedures.
- Injuries from medical procedures on or around your spine, such as epidural anesthesia and spinal taps .
Non-injury causes
In about 10% of cases, CSF leaks happen for unknown reasons. However, experts have connected this problem to a few other medical conditions. Whether or not they cause CSF leaks is not yet known, but they do happen often enough that researchers are now looking to see if there is a cause-effect relationship.
- Connective tissue disorders that could cause a weakness in the layers of tissue that should contain the CSF .
- Structural defects in how your nose, sinuses or other parts of your skull formed .
What Is Cerebrospinal Fluid
Cerebrospinal fluid is a clear, colorless liquid that fills the ventricles and canals of the brain and spinal cord and bathes its external surface. The brain produces about 500 mL of cerebrospinal fluid per day, but the fluid is constantly reabsorbed at the same rate and only 100 to 160 mL is normally present at one time. About 40% of it is formed in the subarachnoid space external to the brain, 30% by the general ependymal lining of the brain ventricles, and 30% by the choroid plexuses. Cerebrospinal fluid production begins with the filtration of blood plasma through the capillaries of the brain. Ependymal cells modify the filtrate as it passes through them, so the cerebrospinal fluid has more sodium chloride than blood plasma, but less potassium, calcium, and glucose and very little protein.
Cerebrospinal fluid serves three functions for the brain:
Long Term Side Effects Of Csf Leak
Long term side effects of CSF leak is usually good depending on the cause. Most CSF leaking cases heal by themselves with no lasting symptoms.
If the CSF leak keeps coming back, high pressure of the CSF might be the cause and should be treated.
Rebound Intracranial Hypertension
Rebound intracranial hypertension can be a complication of epidural blood patching or surgery performed to resolve a CSF leak. It is characterized by increased intracranial pressure, resulting in potentially severe headache, nausea, and vomiting.
As a condition, it has only relatively recently begun to be recognized by doctors, however there are now a number of good medical papers documenting its existence and discussing ways to manage it. It is still not uncommon, however, for many neurologists and other specialists to be unaware of its existence.
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Rapid Treatment For A Full Recovery
A cerebrospinal fluid leak is a condition in which the protective fluid surrounding the brain the CSF leaks into the sinuses or the ears.
Normally the brain is a sterile compartment that is separated from the sinuses and the ears by a bony separation called the skull base. CSF surrounds the brain and cushions it. A thick, leathery tissue called dura lines the inside of the skull, providing a seal that prevents spinal fluid from escaping. CSF leaks occur when there is a breakdown in this barrier.
The dura can be damaged by certain surgeries, head trauma, and tumors. Leaks sometimes occur spontaneously. Untreated CSF leaks can lead to life-threatening meningitis, brain infections, or stroke.
UT Southwestern specialists offer rapid, accurate diagnosis of this dangerous condition, world-class surgical services to correct it, and pre- and post-surgical care that optimizes each patients treatment and recovery.
When A Runny Nose Is Brain Fluid Leaking: Here Is What To Do
Most cases of runny noses are not from central spinal fluid leaks.
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It’s not snot. It’s leaking brain fluid.
That’s what Greg Phillpotts learned after suffering from a runny nose for 5 years, as described by Josh Chapin for ABC 11 Eyewitness News. Here’s a Tweet from Chapin:
He thought it was just allergies or even just a runny nose. It turned out to be something he needed surgery for. Its all next at 11 #ABC11@MountSinaiNYC
Josh Chapin
It turned out that Phillpotts was not experiencing constant allergies as he had been told previously. Instead, cerebral spinal fluid was leaking out into his nose. CSF is a fluid that surrounds your brain and spinal cord, cushioning, protecting, and supporting those parts of the body. CSF is one of the reason your brain doesn’t land with a thud every time you do a jumping jack or listen to Metallica. Normally, the membranes keep the CSF contained, a bit like a big water balloon around your brain and spinal cord. However, anything that may damage the membranes, such as a head injury, surgery, or a tumor, may leave a hole though which the fluid can leak out, potentially into your nose or ear.
Here’s a TODAY show segment about another person who had a somewhat similar experience:
If conservative approaches don’t resolve the leakage, surgery may be in order. Depending on where the defect is located, your doctor may be able to fix it with using a scope.
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Very Rare Occurrence Might Have Been Avoided With Proper Technique
Prior reports of iatrogenic CSF leaks from intranasal procedures have identified surgical trauma at the cribriform plate as the cause in 8% to 58% of cases.
“Idiopathic intracranial hypertension is a risk factor for meningocele formation, and this patient had an undiagnosed skull base defect at the fovea ethmoidalis that was present on imaging dating back to 2017,” the authors write.
“We therefore theorize that the swab itself did not result in a violation of the bony skull base, but rather the invasive test caused trauma to the patients preexisting encephalocele.”
Walsh said that proper technique during the nasal swabbing might have avoided this complication.
“This is a unique situation in that, undoubtedly, this patient had something that predisposed her to have a CSF leak that was present for at least 2 years based on a review of some older information, and most likely…the swab injured this CSF-filled encephalocele at the time, because the swab was up high instead of down low,” Walsh told Medscape Medical News.
“The way to avoid issues like this would be to follow the CDC guidelines for swabbing…. If you’re going for the nasopharynx, the swab is parallel to and run along the floor of the nose, which keep you away from the skull base,” he explained.
“Clinicians should stick to the appropriate testing patterns and be aware of certain populations who might be a higher risk for inadvertent injury,” Walsh said.
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Factors Determining The Glucose Concentration Of Respiratory Secretions
We have adapted the glucose oxidase stick technique to measure the glucose concentration of nasal secretions in the absence or presence of rhinorrhoea. Glucose oxidase sticks were placed in contact with the nasal mucosa under direct vision using an otoscope and nasal secretions allowed to wet the glucose oxidase for 30 seconds. On removal, coating of the stick by secretions was verified by inspection. The stick was wiped after 30 seconds and read against a visual colour scale after a further minute. Using this technique we found that glucose was not detectable in nasal secretions from 20 healthy volunteers with normal nasal mucosa and normal blood glucose. Glucose was, however, present in nasal secretions of 12/24 people with nasal inflammation due to viral colds at 12 mmol.L1. Ten of the people with detectable nasal glucose were re-tested two weeks later when rhinitis had resolved and nine of these no longer had glucose in nasal secretions. The person who still had detectable nasal glucose had persistent coryzal symptoms. Nasal epithelial inflammation induced experimentally by five or more repeat insertions of glucose oxidase sticks also increased the glucose concentration of nasal secretions from undetectable to 0.9±0.5 mmol.L1 in healthy volunteers.
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What Happens If Csf Leak Is Not Treated
Untreated CSF leaks can lead to life-threatening meningitis, brain infections, or stroke. UT Southwestern specialists offer rapid, accurate diagnosis of this dangerous condition, world-class surgical services to correct it, and pre- and post-surgical care that optimizes each patient’s treatment and recovery.
How Common Are Csf Leaksand How Do They Occur
A spontaneous CSF leak is most common in people of childbearing age, Dr. Patel said, but it can happen to people of all sexes and at any age. Overweight individuals are also at increased risk since obesity is associated with idiopathic intracranial hypertension, which is increased blood pressure inside the skull that can create a CSF leak.
Research has suggested that spontaneous CSF leaks affect at least five out of every 100,000 people each year, and experts believe that many more people may go undiagnosed for long periods of time.
That number doesn’t include CSF leaks that are caused by trauma. CSF leaks can occur after a head, brain, or spinal surgery a spinal tap or any type of injury to the head.
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What Causes Csf Rhinorrhea
There are many causes of leakage of CSF into the nose. CSF rhinorrhea may be caused by prior surgeries involving the nose, sinuses, or brain. Such surgeries may cause damage to the bony enclosure of the brain that leads to communication with the nose. CSF rhinorrhea may also be caused by head trauma, specifically those involving blunt trauma to the skull as experienced in high-speed motor vehicle collisions. CSF leaks may also occur spontaneously secondary to underlying medical conditions such as Polycystic Ovarian Disease, or uncontrollable hypertension. Other causes of CSF rhinorrhea may be due to benign or malignant tumors of the brain. However, often times CSF rhinorrhea is idiopathic, having no identifiable cause.
How Is It Diagnosed
A healthcare provider can diagnose a CSF leak using a physical examination, along with gathering information about your symptoms, and asking questions about your medical history and circumstances. Its also very likely that theyll use certain kinds of lab tests and diagnostic imaging scans to confirm or rule out a CSF leak.
The combination of tests and methods they use depends on the suspected location of the leak, and whether or not you have any injuries that could play a role.
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Blunt Injury Of Middle And Posterior Fossa
Fractures that extend from the petrous bone to the middle ear can cause otorrhea if the tympanic membrane is torn. Otorhinorrhea can also occur along to the tract of Eustachian tube. Temporal bone fractures are transverse type in 10% to 30% and longitudinal type in 70% to 90%. Frequencies of CSF fistula are constant regardless of each fracture type. And if a fracture extending from the greater wing of the sphenoid to the sphenoid sinus occurs, a rhinorrhea may also occur, even though it is a middle fossa fracture.
How Are Csf Leaks Treated
Some CSF leaks require a CT scan or a spinal tap for diagnosis, but if you’re able to collect a sample of the liquid, healthcare providers can also test it for a specific protein that’s only present in cerebrospinal fluid.
Once a CSF leak is diagnosed, it can usually be repaired with non-invasive surgery. “In most cases, when there is a nasal leak, we do the surgery entirely through the nosejust like we would do sinus surgery,” Dr. Patel said.
If a leak was caused by trauma or surgery, patching the hole is usually sufficient, Dr. Patel added. But if it was a spontaneous leak, meaning it was caused by a buildup of pressure over time, it’s important to address the underlying cause so another leak doesn’t develop.
“That means there needs to be long-term management of whatever it was that caused that increased pressure,” Dr. Patel explained. “That could mean weight loss, diet changes, or medications that can bring down the pressure.” Some people need to have shunts implanted to regularly drain cerebrospinal fluid and keep their pressure controlled as well.
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Repair Of Csf Otorrhea
A CSF leak into the ear requires traditional surgical incisions. The surgical option depends on the location of the leak. If the leak is in the posterior fossa toward the back of the skull an outpatient surgery can usually correct the problem. A leak near the middle cranial fossa near the center of the skull requires a craniotomy, for which the patient will need to spend three to four days in the hospital.
What Can I Expect If I Have This Condition
CSF leaks are sometimes tricky to diagnose, but the overall outlook for this condition is good. While the symptoms can be unpleasant, severe or disruptive, this condition is usually treatable. The overwhelming majority of people who have CSF leaks will either recover when the leak heals or with treatments or surgeries.
How long does a CSF leak last?
CSF leaks can last days, weeks or even months, depending on the size of the leak and why it happened. Treatment can also greatly shorten how long you feel the effects of a CSF leak. Your healthcare provider is the best person to tell you more about how long this condition will affect you and what you can do to help yourself.
Whats the outlook for this condition?
Overall, the outlook for CSF leaks is very good. About 98% of people with CSF leaks will recover from them, no matter the cause.
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Implications For Use Of Glucose Measurements To Detect Csf Leak
We propose a simple algorithm to optimise the use of glucose measurement for the bedside detection of CSF leak in the emergency department . If rhinorrhoea contains glucose, the specificity of the test for CSF can be improved by excluding other factors that increase the glucose concentration of nasal discharge. If the nasal discharge is not blood stained, the blood glucose is < 6 mmol.L1, and there are no other symptoms of upper respiratory tract infection, such as sneezing, nasal blockage, cough, sore throat, sputum, or purulent nasal discharge, then this increases the likelihood that the discharge contains CSF. If rhinorrhoea does not contain glucose, then either it does not contain CSF or CSF glucose concentrations are below the limit of detection by the sticks . CSF glucose concentrations may be low in people with bacterial meningitis, subarachnoid haemorrhage, neoplasia, and neurological complications of connective tissue disease. As both bacterial meningitis and subarachnoid haemorrhage may complicate head trauma, these should be considered in patients with glucose-free rhinorrhoea before ruling out a CSF leak. In people with recent head injury who do not have blood stained nasal discharge or clinical features suggestive of meningitis or subarachnoid haemorrhage, it is likely that glucose free secretions do not contain CSF.
Are Csf Leaks From The Nose Dangerous
CSF leaks are concerning as it demonstrates communication between the sterile and clean environment of the brain and spinal cord, and the non-sterile conditions of the nose and sinus areas. Although not imminently life-threatening, CSF leaks may have debilitating consequences when unrecognized and untreated. Bacteria may travel from the nose to the brain causing infections that result in meningitis or brain abscesses. For these reasons a timely and accurate diagnosis should be made so that appropriate steps can be taken to treat and prevent such debilitating infections.
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What Medications Or Treatments Are Used
The treatments you receive depend most on what caused the CSF leak and its location. Medications, surgeries and other non-surgical procedures can often help. Your healthcare provider is the best person to tell you about the medications they recommend and why they feel those will help in your specific case.
Conservative treatment
Conservative treatment is a non-direct way of treating CSF leaks. This treatment calls for a person to lie down and rest for a period of time. They’ll also need to stay hydrated, and medications to treat inflammation and pain are common. Caffeine and salt may also be part of the treatment guidelines in cases where a leak causes low CSF pressure. If conservative treatment doesnt work after one to two weeks, your provider will likely recommend moving to direct treatments.
Surgery and related procedures
Surgery is a common method to repair CSF leaks. The surgery can either directly close a leak or help reconstruct a damaged area when the leak is from a significant injury. Some surgeries may go through your skull to access a leak, while others might try to repair a leak through your nose or mouth. The location, cause and severity of the leak are often key factors in deciding the type of surgical procedure.
Blood patch injections
Medications
Complications or side effects of the treatment
What Is A Csf Leak
A CSF leak is when the CSF escapes through a tear or hole in the dura, the outermost layer of the meninges, which surround the brain. The dura can be injured or punctured during a head injury or a surgical procedure involving the sinuses, brain or spine. It may also be damaged by a lumbar puncture, including a spinal tap, spinal anesthesia or myelogram. Spontaneous CSF leaks can occur due to increased intracranial pressure . This can happen to patients with hydrocephalus, a buildup of CSF in the skull. Spontaneous leaks may also occur without an identifiable cause.
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