What Are The Signs Of A CSF Leak & Best Way To Treat It?

About CSF Leak:

Cerebrospinal Fluid also known as the CSF is a fluid constituted of proteins and glucose that surrounds the subarachnoid space of the central nervous system. This fluid is primarily found in the ventricles that surround the brain and within the spinal column. The function of the CSF is to protect the brain and the spinal cord as it provides the necessary cushion to them from any injury. It also regulates the temperature in the central nervous system. The CSF also allows the brain to retain its shape despite not having any potent support structure.[1]

The CSF always remains within its allotted space; however, at times, there is a leak in the CSF. A CSF leak can be extremely detrimental to the functioning of the brain as it disrupts the supply of oxygen to the most vital organ of the body. A lack of adequate blood supply to the brain decreases its function and can destruct the brain parenchyma. A CSF leak can also lead to serious central nervous system infections like meningitis.[1]

A CSF leak generally occurs whenever there is a tear in a layer of tissue called as the dura matter that encompasses the brain and holds the CSF in its place. Once out of the dural matter, the CSF may leak out through the nose and ears or may enter other parts of the body. The muscles and connective tissues surrounding the brain can also get infiltrated by a leaking CSF. Since a CSF leak requires emergent medical attention, it is vital to know its signs and the best ways to treat it.[2] This article highlights the signs and treatment options for a CSF leak.

What Are The Signs Of A CSF Leak?

The Spinal CSF Leak Foundation opines that the most common symptom of a CSF leak is a severe headache which worsens in severity when the head is held upright such as in a standing or a sitting position. The headache calms down significantly when the individual lies down. In some cases, people with a CSF leak may experience headaches through the entire day with no change in the severity or intensity with sitting or lying down.[2]

Another sign of a CSF leak is constant drainage of a clear fluid from the nose and ears, especially with any sort of head movements like bending forward. Some people also complain of a metallic taste in the mouth. Ringing in the ears is also sometimes noticed in people with a CSF leak.

Vision disturbance is also something that is quite common in people with a CSF leak along with hearing loss.[2]

What Are The Best Ways To Treat A CSF Leak?

The treatment for a CSF leak can be broadly divided into three categories based on the severity and the cause of the leak. These include conservative treatments, invasive treatments, and surgery.[2]

Conservative Treatments for CSF Leak: This form of treatment for a CSF leak focuses mainly on managing the symptoms caused by it. It includes ample amount of rest, proper hydration, and pain medications. Sometimes, infusion of caffeine injections is also quite effective in managing the symptoms caused by a CSF Leak.[2]

Invasive Treatments for CSF Leak: This form of treatment becomes necessary when there is no improvement seen with conservative treatments. An invasive treatment involves performing an epidural blood patch. This is a procedure in which blood of the patient is used to patch up the area of the dural tear to plug the leak. Approximately, 25 mL of the patient’s blood is taken and injected in the space around the area of the tear. This procedure is generally successful but is not optimal for all types of CSF leaks.[2]

According to a study done in 2016 where the success rate of an epidural patch for CSF leaks was analyzed, a group of people were divided into two where one group had CSF leak due to medical procedure and the other group there was no identifiable cause for the leak. The study showed that 91% of people with CSF leak due to medical procedure required just one epidural patch to successfully cure the leak. However, in the other group only 40% experienced full recovery and the others required additional treatments.[2]

Surgery for CSF Leak: A surgery is normally recommended for people where a CSF leak does not heal on its own and all other forms of conservative and invasive treatments are deemed to be ineffective. Surgery is also recommended in cases where a blood clot or a herniated brain tissue is responsible for the CSF leak. People with meningitis as a result of CSF leak also are recommended surgical treatments to deal with the leak.[2]

The surgery involves repairing the tear in the dural matter with suturing or stitching to plug the leak and prevent any further CSF leak. The repair of the tear is either done using an endoscopic or an open approach.[2]

An endoscopic approach is effective in treating CSF leaks that occur due to a tear in the dura mater in the front of the head causing the fluid to leak from the nose. In this procedure, an endoscope is passed through the nose to the area of the tear which is repaired by tools passed through this endoscope.[2]

An open approach is taken if the CSF leak causes fluid to drain from the ears. The procedure involves making an incision in the scalp, identifying the tear and repairing it. The success rates of both of these approaches are quite similar even though endoscopic repair has far less risk associated with it than the more traditional open approach towards treatment of a CSF leak. A study shows that both endoscopic and open approaches for treating CSF leaks have an approximately 90% success rate.[2]

To summarize, CSF is a clear fluid rich in proteins and glucose that encompasses the brain and is present within the spinal cord. It protects and cushions the brain and spinal cord. A CSF leak occurs when there is a tear in the tissue called the dural mater that surrounds the brain causing the fluid to seep through the tear and drain out from the nose and ears. At times, it also enters other parts of the body as well.[1, 2]

Severe headaches when sitting upright is the most common sign of a CSF leak along with persistent drainage of clear fluid from the ears and nose. A CSF leak requires emergent medical attention and delay in treatment can be detrimental to the functioning of the brain. CSF leaks can be treated conservatively, through an invasive approach, or surgically. The details of all the approaches have been mentioned above. Studies have shown about 90% success rate in the treatment of people with CSF Leak.[1, 2]

References:

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