CSF Leak Treatment

Introduction

CSF fluid is present in the brain and spinal cord. The fluid start leaking due to various reasons. Patients experience nausea, vomiting, headache, and nasal discharge. The doctor diagnoses the condition through imaging methods. Treatment is through both invasive and non-invasive technique.

Cerebrospinal Fluid

The brain is an important organ. It controls all the vital functions of the body. There is a need to protect the brain and to supply essential nutrients. The cerebrospinal fluid serves these purposes. Brain secretes the cerebrospinal fluid. The fluid acts as a cushion to the brain and protects it from injury. Further, the fluid also keeps the brain in a buoyant state that allows the proper blood supply. It is present inside the three membranes that surround the brain. CSF is also present in the spinal cord.

 

Cerebrospinal Fluid Leak

Patients may experience a cerebrospinal fluid leak. The CSF leak may occur when the CSF moves out from the defined area. It is due to the holes in the brain membrane. The CSF fluid leaks from the brain. It spreads to other parts of the body through the nose or ears.

When the CSF escapes through the nasal cavity, the condition is known as CSF rhinorrhoea. Leakage of CSF may result in severe complications. CSF leakage may also occur through the spinal cord.

Symptoms Of Cerebrospinal Fluid Leak

Following are some of the symptoms of fluid leakage:

• Headache when the person sits or stands
• Nausea and vomiting
• Increased sensitivity to light and sound
• Pain and stiffness in the neck
• Change in hearing pattern
• Metallic taste in the mouth
• Nasal drainage
• Ear drainage
• Tinnitus or ringing in the ears

Causes Of Cerebrospinal Fluid Leak

There are various causes of CSF leakage. Some of them are:

• Injuries to the head: Most cases of CSF leakage occur due to head injuries. There is damage to the skull bone that may also puncture the membranes of the brain. It results in CSF leakage.
• Brain tumour: Tumor in the brain may also result in CSF leakage.
• Infection: Infection of brain tissue is known as encephalitis, while infection of the brain membrane is known as meningitis. When both are present at a time, the condition is known as encephalomeningitis. These infections may result in CSF leakage.
• Injection: Epidural injection, a lumbar puncture, or anaesthetic injection may cause CSF leakage.
• Surgery:Any surgery of the brain or the spinal cord may result in a CSF leak.
• Congenital anatomical abnormality: There are various structural abnormalities related to the skull are present at the time of birth. These abnormalities may result in CSF leakage.

Risk Factors For Cerebrospinal Fluid Leak

Various factors increase the risk of CSF leak. Some of them are:

• Obstructive sleep apnoea
• High intracranial pressure
• Meningitis
• Head injury
• People exposed to the risk of accidents or trauma.
• People undergoing surgery of the brain and spinal cord

Diagnosis Of Cerebrospinal Fluid Leak

The neurologists diagnose the CSF leakage through the following methods:

• Physical examination: The doctor may perform the physical evaluation to determine the CSF leakage. The doctor may also take information about the medical history of the patient.
• Imaging techniques: If the doctor suspects a CSF leak, he may advise the patient to undergo imaging tests. The tests may include a CT scan and an MRI.
• Cisternogram: The doctor may also recommend for cisternogram. It may be used without pledgets in case of spinal leaks, and with pledgets in case of CSF leak.
• Myelography: Myelography is the technique for taking images of the spine and spinal cord. It helps in determining the location and extent of the abnormality.
• Pledget study:In this study, the doctor places cotton pads into the nostrils. The secretion from the nose is sent to the laboratory to diagnose the CSF leak.

Treatment For Cerebrospinal Fluid Leak

Following are the treatment options for CSF leak:

• Symptomatic treatment: The doctors manage the symptoms through conservative treatment. Conservative treatment involves the following:
• Staying hydrated
• Analgesic drugs
• Complete rest
• Caffeine infusion
• Epidural blood patch: If the conservative treatment did not provide relief to the patient, the doctor opts for an epidural blood patch procedure. In this method, the surgeon takes the patient’s blood and injects it into the durameter at the leakage site. It is an effective method and has good efficacy in managing the leak.
• Surgery: The doctor may recommend the surgery to patients with severe CSF leakage and clotting in the brain or spinal cord. The surgery is minimally invasive and involves stitching of the hole.

Complications Of Cerebrospinal Fluid Leak

Untreated CSF leak may have various complications such as:

• Meningitis
• Stroke
• Encephalitis
• Headache
• Seizures
• Coma

Prognosis Of Cerebrospinal Fluid Leak

Prognosis is positive in cases where the CSF leak is diagnosed at an early stage. Managing the disease quickly also reduces the risk of complications. If the patient under conservative treatment had no relief from symptoms within 8-10 days, the doctors opt for surgical intervention. The effect of treatment is different in different people. Some people become symptom-free after surgery, while some continues to experience symptoms.