Spinal CSF Leak Patient Guide

Spinal CSF Leak Patient Guide

Spinal CSF Leak Patient Guide

Treatable Cause of Headache

The most common cause of intracranial hypotension is a cerebrospinal fluid (CSF) leak. CSF is the fluid that cushions and protects the brain and spinal cord. It is contained within a saclike covering called the meninges. Normally, the brain floats in this fluid. The outermost layer of the meninges is called the dura. If there is a hole or tear in the dura, the fluid will leak out and cause symptoms of CSF leak. If the volume of CSF becomes low, the brain will sag in the skull causing headaches that worsen when in an upright position and improve when laying flat.

Causes
A CSF leak can occur after some medical procedures such as a lumbar puncture (spinal tap), epidural injections or spinal surgery. Sometimes, however, CSF leaks occur spontaneously, making the diagnosis a bit more challenging. Often times there is a weakened or torn dura, which can be discovered by obtaining thorough medical history. This may occur from activities that cause strain in your back such as roller coasters, lifting heavy items, straining, stretching, falls or car accidents.

In some cases, however, there is no triggering event reported.

There are certain genetic disorders that are also associated with CSF leaks because they are more likely to weaken the dura or connective tissues. These include:

Symptoms
The most common symptom of intracranial hypotension is a headache that is worse when upright and better when lying down. This is known as a positional headache. Headaches often start within 15 minutes of sitting or standing up and improve after 15–30 minutes of lying down.

However, this is not always the case. Sometimes headaches can take hours to worsen or improve with position changes. Headaches are often located in the back of the head and is often described as a “pulling” sensation from the head to the neck. Headaches can range from mild to incredibly debilitating.

Other common symptoms include: neck pain and stiffness, nausea, sensitivity to light or sound, dizziness or vertigo, ringing in the ears or changes in hearing. Less commonly, patients report pain between shoulder blades, facial numbness or pain, visual changes, or changes in taste. In extreme cases, intracranial hypotension can lead to very unsteady gait, weakness, decreased level of consciousness or coma.

CSF Leak Diagnosis
 Fortunately, there have been many advances in the diagnosis and treatment of this rare condition over the past decade. Some examples of the imaging tools used to diagnose CSF leaks include:

  • CT (computed tomography): Often used to rule of hemorrhage in the brain
  • MRI (magnetic resonance imaging): Scan of the brain with and without contrast is important to look for common specific findings of CSF leak. In about 80 percent of cases, the MRI of brain will show a series of findings common in CSF leaks including:
    • Subdural fluid collections
    • Enhancement of the meninges
    • Engorgement of venous structures
    • Pituitary swelling
    • Sagging of the brain
    • MRI of the spine may also reveal cerebrospinal fluid collections at the site of leak
  • Dynamic Myelogram: This is a procedure in which a physician injects contrast dye directly into the spinal canal and watches for leakage under X-ray and CT
  • CT myelogram
  • Digital subtraction myelography

CSF Leak Treatment
Fortunately, there are treatment options available for intracranial hypotension caused by CSF leak. For many patients, symptoms may go away without any specific treatment. Initial treatment is often conservative and includes bed rest, fluids and caffeine intake to reduce headaches.

If conservative treatment does not work, the most common treatment is an epidural blood patch. This is done by injecting the patient’s own blood into the epidural space outside the dura. This creates a plug and prevents CSF from leaking. Epidural blood patches can be done successfully even when the exact location of the leak is unknown and can be repeated several times. Another type of patching involves using a substance called fibrin, which is a glue like substance and is injected at the specific location of the leak.

In some cases, surgery may be recommended if these treatments do not work. Surgery focuses on fixing the underlying cause of the problem and may use sutures, clips or synthetic sealants to repair the dural tear.

CSF Leak Prognosis
The prognosis is very good for patients with CSF leaks. Many may not even require medical attention. The majority of patients that do require medical treatment do very well with the appropriate testing and treatment.