It was “like a waterfall, continuously,” Kendra Jackson told KETV in Omaha, Neb., of the years-long runny nose that she recently learned was a brain leak. “Everywhere I went, I always had a box of Puffs.”
Jackson, who was officially diagnosed with a cerebrospinal fluid (CSF) leak, remembers the chronic runny nose starting back in 2013, after a minor car accident caused her head to slam into the dashboard. Although she walked away mostly unscathed, the incident left Jackson with intermittent headaches and a runny nose so frequent that she was almost constantly wielding tissues.
Over the years she’d seen a variety of doctors, most of whom attributed it to allergies. But when she felt the condition worsening in recent months, causing fatigue and dizziness, Jackson wondered if something else might be wrong This month, thanks to doctors at Nebraska Medicine, she learned what was. While examining her brain through an MRI, doctors identified a small hole at the base of her skull that was causing brain fluid leak out of her nose. In total, she was losing a half-pint of cerebrospinal fluid a day.
While in years past, a diagnosis of CSF leak would require open-brain surgery, the condition can now be treated using a minimally invasive surgery through the nose. In Jackson’s case, this involved plugging the hole with fatty tissue from another part of her body. The surgery, which Nebraska Medicine captured in video, went well — and Jackson is now recovering.
“I don’t have to carry around the tissue anymore,” she told KETV in a post-surgery interview. “And I’m getting some sleep.”
So what exactly is a CSF leak, and is it something you should be worried about?
According to the Cleveland Clinic, a CSF leak “results when the the fluid that surrounds and protects the brain (called cerebrospinal fluid)” leaks through a hole that has developed in the skull bone. The hole can be caused by trauma, such as a head injury, or simply occur spontaneously. The main symptoms, on top of watery drainage from the nose, are vision changes, dizziness, headaches, and hearing loss. The condition is both rare and treatable.
Dr. Satish Govindaraj, chief of the Division of Rhinology and Sinus Surgery for the Mount Sinai Health System in New York, is one of the leading doctors in the field of CSF leaks. Together with his team at Mount Sinai, he has pioneered a “high resolution CT/MRI fusion technique” that allows doctors to better locate the actual site of the CSF leak.
As someone intimately connected to this subject, Govindaraj doesn’t seem particularly surprised by Jackson’s story. “It can happen in someone who has a history of trauma, such as a motor vehicle accident,” Govindaraj tells Yahoo Lifestyle. “They might have a fracture and they didn’t even know it.” To test for the condition, Govindaraj and his team use a serum that can detect brain fluid. But just because someone has a consistently runny nose doesn’t mean they need this test.
On top of noting that it’s an “incredibly rare” condition, Govindaraj raises an important distinction about the symptom of watery drainage. “It would be specifically coming from one side,” he says. “It’s extremely rare to have a leak on both sides, so it’s clear drainage from one side that should raise a red flag.” But even if it is coming from one side, that may not be cause for alarm. “If it’s brain fluid, it would be almost like straight water — like the fluid out of a facet,” he says. “It’s not something where someone has allergies they should run to the doctor and check if they have this.”
In terms of what’s actually causing it, Govindaraj likens it to a pressure cooker in need of a release valve. “When the brain fluid pressure builds, it becomes trapped in the skull, so it ends up leaking where the bone is thinnest,” he says, mentioning the part where our smell nerves connect to our brains. “That hole acts as a decompression.”
Although the leak itself isn’t necessarily dangerous — since the body routinely creates brain fluid — having it exposed to the nasal cavity, which can transport infections, is dangerous. So surgery to plug the hole is recommended immediately. Doing so can bring on more headaches, since the pressure has nowhere to go, but Govindaraj says that’s the next and final step: “We have to manage that pressure.”
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