Cerebrospinal Fluid Leak: When Are Symptoms Serious?
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Medically reviewed by Nicholas R. Metrus, MD
Cerebrospinal fluid (CSF) can leak if there is a tear or injury to the dura, a membrane that surrounds the brain and spinal cord. Though are, spontaneous or unexplainable cerebrospinal spinal fluid leaks can occur and are serious.
People at risk for CSF leaks include those with a head injury, those who have undergone recent spinal or brain surgery, those who have had a lumbar puncture, and those who have an abnormal buildup of cerebrospinal fluid in the skull (a condition called hydrocephalus). Treatments will depend on the cause.
This article explains what symptoms to watch for, risk factors, what to expect from a specialist, and what recovery from a cerebrospinal fluid leak looks like.
Related: The Anatomy of the Spinal Cord
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Cerebrospinal Fluid Leak: Symptoms to Recognize
CSF is made in the brain, It flows in and around the brain and down the spinal cord. If there is a leak in the system, symptoms can (but don't always) occur. These symptoms can include the following:
Headache
Drainage from nasal cavity (can be difficult to tell difference between nasal dripping or draining and CSF)
Tinnitus (ringing in the ears)
Changes in vision
Headache: When to Call a Healthcare Provider
If you have a headache that persists for a week, it's time to consult with a healthcare provider about the cause of it. An unrelenting headache is a sign of possible CSF leak.
Who Gets Cerebrospinal Fluid Leaks?
Anyone can experience a cerebrospinal fluid leak. People at greatest risk are those with a history of minor head trauma, degenerative changes to the spine, connective tissue disorders, previous head injuries, or a buildup of cerebrospinal fluid in the skull. There are also certain medical procedures that increase the risk of CSF leak due to the risk of injury during surgery.
Medical procedures associated with increased risk for CSF leak include:
Peridural anesthesia (pain management treatment)
Brain or spine surgery, or spine-related surgical interventions
Spontaneous CSF Leaks
While diagnostic tests are available, it is still difficult to determine the exact cause of the CSF leak. This means it can be difficult to fully determine who is at risk of CSF leak. Spontaneous leaks are incredibly rare, which is an average incidence of 0.001 percent (1in 100,000).
Related: The Anatomy of the Lumbar Spine
When Is a Cerebrospinal Fluid Leak Serious?
If you suspect your symptoms may suggest you have a cerebrospinal fluid leak, consult with a healthcare provider. If you experience CSF leakage in the ears or nose, seek medical care and treatment from a healthcare provider. as they can lead to a meningitis infection.
Bacterial meningitis symptoms include sudden onset:
Fever
Stiff neck
Additional signs and symptoms of bacterial meningitis infection include:
Nausea or vomiting
Photophobia (increased light sensitivity)
Confusion
Seeing a healthcare provider is important. A provider can determine whether or not you have a CSF leak and if you should start treatment to reduce symptoms and the risk of meningitis. Patients with tears in the dura or people experiencing persistent CSF leaks may require a repair to reduce pain and the risk of meningitis.
When to Call 911
If you experience any signs and symptoms of meningitis, seek immediate medical care from a healthcare provider. Untreated, meningitis can lead to seizures or a coma, and can even be fatal or result in a permanent disability.
If you show symptoms of CSF leak, the following diagnostic tests may be suggested:
Nasal fluid analysis to check for a type of protein found in CSF fluid
Computed tomography (CT) scan to examine bones and the planes protecting the brain
Magnetic resonance imaging (MRI) scan to help locate the leak and determine severity
Spinal tap or lumbar puncture that adds a specific fluid to CSF to help determine leak location
CT cisternogram utilizing an injectable contrast medium and CT scan to help find a CSF leak associated with the nasal cavity or mastoid bone
Pledget (cotton ball) test with an injectable radioactive tracer and cotton balls inserted into nose to collect fluid leak and help confirm if CSF is leaking into the nose or mastoid bone at the base of the skull
Myelogram scan with an injectable contrasting medium and MRI or CT scan to look for tears or ruptures in the dura
Healing a Cerebrospinal Fluid Leak Without Treatment
A CSF leak is serious. However, this doesn't mean treatment is always necessary. Experts say most CSF leaks will resolve on their own within a few days. Bed rest is recommended to help with the healing process.
Even if you do not receive a surgical intervention for CSF leak, you may still be advised to take some medication at home to help with symptoms, including swelling and headache pain. Experts also suggest drinking caffeinated beverages to help stop or slow the leak.
Seeing a Specialist for Cerebrospinal Fluid Leak Treatment
Treatment for CSF leaks requires seeing a specialist (usually a neurologist) who can determine the leak location and a surgeon who can seal the leak.
Ear CSF Leak
A specialist may make a surgical opening or cut in the skin behind the ear and remove portions of the mastoid bone. Then they may be able to access the leak location and seal it off using your own tissue or a tissue graft.
Nasal CSF Leak
Nasal CSF leak treatment doesn't require making a surgical opening. Instead, the surgeon will enter the nasal cavity and repair the leak using your nasal tissues or a biomaterial as a graft. In this procedure, patients may also have a lumbar drain that is then removed before heading home.
Related: Sinus Surgery: Everything You Need to Know
Spinal CSF Leak
When the CSF leak is located in the spine, options for treatment include sewing the dura or using patches to seal the leak. Sometimes blood or fibrin (an insoluble protein found in blood that aids in clotting) are used as patches. The patches are injected into the spinal canal under the guidance of CT imaging.
If these procedures are not enough to stop the leak, then another method may be used. A duraplasty is when the dura is surgically repaired.
Side Effects of CSF Leak Treatment
Risks associated with CSF leak treatment vary depending on the initial size of the leak, the cause of the leak, and which method or treatment is used. Generally speaking, side effects of CSF treatment will include pain, swelling, or discomfort near the incision sites.
Risk of infection is possible with any surgical intervention. A healthcare provider will explain the risks and side effects associated with certain medications or procedures.
Cerebrospinal Fluid Leak Recovery Timeline
The exact timeline for CSF leak recovery will depend on the leak size, location, and the cause of the leak, if known. Generally speaking, CSF leaks resolve in a few days without treatment. And if surgery is necessary, patients may require a two- to three-day hospital stay after the procedure. A healthcare provider is the best person to provide the most accurate timeline for recovery.
Summary
A cerebrospinal fluid leak is when CSF leaks from the brain or spine. CSF leaks can occur after a lumbar puncture, head injury, brain surgery, or spine surgery. Spontaneous leaks can also occur but are rare. CSF leaks can be serious but surgical treatment isn't always necessary.
Treatments include letting it heal on its own, taking medication for symptom management, or having a surgical procedure to stop the leak. Side effects of surgery can include pain and discomfort. The recovery timeline depends on many factors. Many patients spend two to three days in hospital after a surgery for CSF leak.
