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Csf Leak

Alternate Names

  • cerebrospinal fluid fistula
  • Brain and spinal cord

Definition

Cerebrospinal (CSF) leak is an abnormal drainage of cerebrospinal fluid from the subarachnoid space in the brain.

What is going on in the body?

CSF essentially bathes the brain and spinal cord and protects them from injury and infection. CSF is formed within the inner spaces of the brain called ventricles. The fluid travels through the ventricles and exits the brain beneath the cerebellum, which is at the base of the head. It then travels down the spine, around the spinal cord and nerves, and back up to the head.
Finally, it passes over the top of the brain where it is absorbed. The fluid is held between the arachnoid and dura membranes. These membranes cover the brain and spinal cord. Leakage occurs when the arachnoid membrane is ruptured.

Risks

What are the causes and risks of the condition?

A CSF leak is caused by a rupture of the arachnoid membrane. This usually results from trauma, surgery or after a spinal tap. It can also occur spontaneously. Tissue destruction caused by tumors can also lead to a CSF leak.

Prevention

What can be done to prevent the condition?

There is no way to prevent a CSF leak from trauma, lumbar puncture, or surgery. Sports safety guidelines for children, adolescents, and adults can help avoid head injury during sports.

Diagnosed

How is the condition diagnosed?

Diagnosis is made by a complete history and physical by a trained health professional. If fluid is actively flowing out of the nose, ears, or a head wound, the fluid can be tested to verify that it is CSF.
Headache is a common symptom resulting from CSF leak. If the headache improves with lying down and worsens with standing or sitting, a CSF leak can be assumed, particularly if the individual has recently undergone a lumbar puncture or other procedure where the arachnoid membrane was breached.

Long Term Effects

What are the long-term effects of the condition?

Chronic leakage may occur at times following surgery, trauma or spinal tap. Headache and infection are the greatest risks.

Other Risks

What are the risks to others?

There are no risks to others.

Treatments

What are the treatments for the condition?

Leakage through the nose or ears following trauma usually gets better with rest. Antibiotics are given if an infection is present. If the leakage persists, the healthcare professional may place catheters in the lumbar spine to reroute the CSF.
Surgical closure of the ruptured membrane is rarely needed. If leakage is caused by erosion due to tumor or infection, the underlying cause must be treated.
CSF leak following a lumbar puncture can be treated with caffeine, and hydration. A blood patch may be placed at the site of the spinal tap. This is a procedure where the individual's own blood is injected at the location of the spinal tap, sealing the hole so as to prevent the leak.

Side Effects

What are the side effects of the treatments?

Infection at the site of trauma or surgery may occur. Failure of the rupture to close spontaneously may sometimes occur.

After Treatment

What happens after treatment for the condition?

Treatment is usually successful, although complications such as infection can occur.

Monitor

How is the condition monitored?

A person should be monitored for infection and recurrence of CSF leakage. A change of therapy may be needed if infection or recurrence takes place. Any new or worsening symptoms should be reported to the healthcare professional.

Sources

Current Medical Diagnosis&Treatment, 39th edition.

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