Description

The cerebrospinal fluid (CSF), which surrounds the brain and spinal cord and provides a cushion to protect them from injury. There are three layers that surround the spinal cord and the brain. When there is a hole or tear in the outer layer, a CSF leak occurs. The hole or tear in the outer layer, called the dura mater, it allows some of the fluid to escape.

There are two different types of csf leaks: spinal csf leaks and cranial csf leaks. Each type has different symptoms, causes and treatments.

Spinal CSF leak occurs in any place of the spinal column. The most common symptom of a spinal CSF leak is a headache.

A skull CSF leak occurs in the skull, and often cause symptoms such as a clear liquid that comes out of your nose or the ear.

Some of csf leaks may heal with rest in bed and the other conservative treatment. Many csf leaks need a patch to cover the hole or the surgery to repair the leak.

Symptoms

The symptoms vary between spinal and cranial csf leaks.

Spinal csf leaks

The most common symptom of a spinal CSF leak is a headache. These headaches usually:

  • This causes pain at the back of the head.
  • Improve when lying down.
  • Worse when it is standing.
  • You can start or get worse when coughing or straining.
  • Rarely, start suddenly. When this happens, it is called a "thunderclap" headache.

Other symptoms of spinal csf leaks may include:

  • Neck or shoulder pain.
  • Ringing in the ears.
  • Changes in hearing.
  • The dizziness.
  • Nausea or vomiting.
  • Changes in vision.
  • Changes in behavior or ability to think clearly.

Skull of csf leaks

Cranial CSF leak symptoms may include:

  • Clear, watery drainage from one side of the nose or the ear.
  • The hearing loss.
  • A metallic taste in the mouth.
  • Meningitis.

Causes

Spinal csf leaks can be caused by:

  • A lumbar puncture, also called a lumbar puncture.
  • Epidural analgesia in the spinal column to relieve pain, such as during labor and delivery.
  • An injury to the head or spine.
  • Bone spurs along the spine.
  • The irregularities of the dura mater around the nerve roots of the spine.
  • Irregular connections between the dura mater and the veins. These are known as CSF-venous fistulas.
  • Before the surgery of the spine.

Cranial csf leaks can be caused by:

  • A head injury.
  • Surgery of the paranasal sinuses.
  • The increased pressure in the brain.
  • Malformations of the inner ear.

Sometimes, csf leaks develop after the events:

  • Sneezing.
  • Cough.
  • Effort to have a bowel movement.
  • Lifting heavy objects.
  • The fall of.
  • The stretch.
  • Exercise.

When there is no surgery or procedure prior to the start of a CSF leak, it is called spontaneous CSF leak.

Risk factors

Risk factors in the column of csf leaks include:

  • Having a previous surgery or procedure in or around the spine.
  • Connective tissue disorders such as Marfan syndrome or Ehlers-Danlos syndrome, down syndrome, which is often also the cause of joint hypermobility and dislocations.

Risk factors for cranial csf leaks include:

  • Having a previous surgery in or around the skull.
  • Obesity.
  • Obstructive sleep apnea.
  • Trauma to the head.
  • Tumor at the base of the skull.
  • The irregularities of the base of the skull or of the inner ear.

Complications

If a skull, CSF leak is left untreated, complications can occur. Possible complications include meningitis and tension pneumocephalus, which is when the air enters into the spaces surrounding the brain. Without treatment, spinal csf leaks can cause subdural hematomas, or bleeding on the surface of the brain.

Diagnosis

Spinal CSF leak

Your health care professional is likely to start by asking about your medical history and perform a physical exam.

Tests to diagnose a spinal CSF leak may include:

  • Magnetic resonance imaging (MRI) with gadolinium. An mri uses a magnetic field and radio waves to produce detailed images of the brain, spinal cord, and other areas of the body. The use of magnetic resonance imaging with gadolinium, which makes it easier to see the changes in the vertebral column, which are the result of a CSF leak. Gadolinium is a substance called a contrast agent that highlights the tissues in the body.
  • Radioisotope cisternography. This test consists of measuring CSF pressure, and then the injection of a chemical substance in the space surrounding the spinal cord. Then, several images of the area taken over a period of 24 hours. These images look at the changes in the flow of CSF, which may indicate a leak.
  • Myelography. This imaging test uses a contrast dye and X-rays or computed tomography (CT) to take detailed images of the spine. You can find the exact location of a CSF leak, and helps determine the best treatment plan.
  • Spinal tap. This test is also called a lumbar puncture. It involves placing a needle into the spinal column to measure the CSF pressure in the interior of the spinal column. It is usually performed as part of another test of CSF leak. For example, a lumbar puncture is required at the start of myelography or cisternography.

Cranial CSF leak

Your healthcare provider will likely start with your medical history and a physical examination. The physical examination includes the assessment of the nose and the ears. You may be asked to lean forward to check for any nasal discharge, which can be collected and sent to a laboratory for analysis.

The tests to diagnose a cranial CSF leak may include:

  • MRIwith of gadolinium. A magnetic resonance imaging can be used to help detect a leak of CSF in the brain. Use with gadolinium, a contrast agent, it helps to highlight the irregularities in the brain and locate the source of a leak of CSF.
  • Tympanometry. This test uses a handheld device called a tympanometer. The probe on the tympanometer is inserted into the ear to measure the function of the middle ear and check the fluids. Clear fluid coming out of the ear is a symptom of a CSF leak.
  • CTcisternography. This test is considered the gold standard for the diagnosis and localization of cranial csf leaks. Using a ct scan and a contrast medium for locating leakage of CSF at any place of the skull base. This test can show you exactly where a CSF leak is, and help determine the best treatment plan. High-resolution CT provides images of higher detail and can also be used.

Treatment

Some of csf leaks to improve with bed rest alone, but the majority of the need for treatment.

Treatments of spinal csf leaks may include:

  • Blood patch Epidural. This treatment involves taking a sample of your own blood, then injected into the medullary canal. The cells of the blood forms a clot, which can create a patch to cover the area where the CSF is leaking.
  • Fibrin. Fibrin is special glue made of substances in human plasma that helps with the clotting of the blood. It is used alone or mixed with their blood, which is injected into the medullary canal to cover the hole and stop the CSF leak.
  • Surgery. Some of csf leaks need of surgery. The surgery is performed if other treatment options do not work, and the exact site of the leak is known. There are several types of surgical treatments for the repair of csf leaks. The surgery may involve the repair of the CSF leak with sutures or grafts made from patches of muscle or fat.
  • Trans-venous embolization. This minimally invasive procedure that is used only for the CSF-venous fistulas. CSF-venous fistulas are irregular connections that occur in the spine and allow CSF to leak fluid into the blood vessels. Trans-embolization, venous stops the leak by the gluing of closure of the fistula from the inside of the affected vein.

Some cranial csf leaks, such as those caused by trauma, can improve with conservative measures, such as:

  • The bed rest.
  • Elevate the head of the bed.
  • Taking laxatives to prevent constipation.

Other cranial csf leaks requiring surgical repair.

Preparing for your appointment

After discussing your symptoms with your health care professional, you could receive a referral to see a doctor trained in brain and spine conditions for further evaluation. Doctors with this workout includes neurologists, neurosurgeons and the ENTs.

Here's some information to help you prepare for your appointment.

What you can do

Make a list of:

  • Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began.
  • Key personal information, including major stresses or recent life changes.
  • All medications, vitamins or supplements that you take, including over-dose.
  • Questions to ask your health care team.

Bring with you to the appointment of the latest results of the tests and scans of his brain and spine. Have a friend or family member, if possible, to help you remember the information that you receive.

For csf leaks, questions to ask your health care provider include:

  • What is likely causing my symptoms or condition?
  • What tests do I need?
  • Is my condition likely temporary or long-term?
  • What is the best course of action?
  • Would losing weight help my condition?
  • I have these other health conditions. How can I best manage them together?
  • There are restrictions that must be followed?
  • You should see a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Your healthcare provider is likely to ask questions such as:

  • The symptoms been continuous or come and go?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of fistula of cerebrospinal fluid (Cerebrospinal fluid leak)