OVERVIEW

What is cerebrospinal fluid leakage?

Cerebrospinal fluid (CSF) production, absorption, and circulation play a crucial role in intracranial pressure dynamics.

Within the intact spinal and cranial cavity, CSF supports brain tissue, acting as a cushion and pressure equalizer. As CSF pressure decreases, the buoyancy provided by the supportive fluid cushion diminishes. Consequently, the brain shifts downward within the cranial cavity, stretching the structures that anchor and support brain tissue.

When a connection forms between the CSF-filled space and the external environment, resulting in CSF leakage, it is termed cerebrospinal fluid leakage. CSF leakage can alter CSF pressure, leading to a range of neurological symptoms, with headache being the most common.

SYMPTOMS

What are the manifestations of cerebrospinal fluid leakage?

• Headache is the most common symptom, with poor response to painkillers. Upright posture, head movement, coughing, exertion, sneezing, jugular vein compression, and high altitude may worsen the headache. Some patients may develop chronic headaches. For some patients, headaches may begin at noon or in the afternoon, and the longer they stand, the more severe the headache becomes.

• Other symptoms include neck pain, nausea, vomiting, as well as hearing abnormalities, loss of appetite, dizziness, blurred vision, etc. Additionally, compression and deformation of brain and spinal cord structures may lead to ataxia, mild limb paralysis, cerebellar hemorrhage, Parkinson's disease, dystonia, and other conditions.

• Furthermore, depending on the location of the cerebrospinal fluid leakage, symptoms such as otorrhea (ear leakage) or rhinorrhea (nose leakage) may also occur.

CAUSES

What causes cerebrospinal fluid leakage?

Cerebrospinal fluid leakage can be classified into three main categories based on its causes: spontaneous, traumatic, and postoperative.

Details are as follows:

• Congenital spinal extradural cysts may rupture or cause tears in the dural nerve sheath due to minor trauma, such as falls, sudden bending or stretching, sexual intercourse, sneezing, or physical activities, leading to cerebrospinal fluid leakage.

• Additionally, degenerative spinal disc diseases, bone spurs, or micro-spurs may also cause dural tears, resulting in cerebrospinal fluid leakage.

• Spontaneous spinal cerebrospinal fluid-venous fistulas are relatively rare.

• Persistent intracranial hypertension can lead to cerebrospinal fluid leakage at the skull base.

Is cerebrospinal fluid leakage contagious?

No, it is not an infectious disease.

Is cerebrospinal fluid leakage hereditary?

No, it is not a genetic disorder.

DIAGNOSIS

What tests are needed for cerebrospinal fluid leakage?

To confirm cerebrospinal fluid leakage, it is necessary to demonstrate low cerebrospinal fluid pressure.

Possible tests include brain MRI and spinal MRI, which help locate the leakage. Other options include CT myelography and radionuclide cisternography.

When MRI or similar tests are unavailable or intolerable, a lumbar puncture may be performed.

TREATMENT

Does cerebrospinal fluid leakage require hospitalization?

Severe accompanying symptoms, such as sudden worsening headache, hearing changes, photophobia, altered consciousness, or Parkinsonism, require immediate hospitalization.

How is cerebrospinal fluid leakage treated?

• For uncomplicated mild-to-moderate cases, conservative treatment includes avoiding upright posture, bed rest, and using analgesics. Restoring cerebrospinal fluid volume through oral or intravenous hydration, oral caffeine, and high salt intake may help. An abdominal binder can also be beneficial.

• If conservative treatment fails after 2 weeks, or if severe headaches, disabling symptoms, traumatic injury, connective tissue disorders, or joint hypermobility exist, an epidural blood patch with autologous blood injection may be performed.

• If the epidural blood patch fails and the leakage site is unclear, continuous epidural infusion can temporarily relieve symptoms.

• Surgical repair may be considered if medical treatments are ineffective.

What happens if cerebrospinal fluid leakage is left untreated?

Mild cases may resolve spontaneously, but moderate-to-severe untreated cases can lead to neurological damage and serious consequences.

Can cerebrospinal fluid leakage be cured?

Mild cases may resolve on their own, while moderate-to-severe cases without irreversible neurological damage can be cured with an epidural blood patch or surgical repair.

Are there any long-term effects after treating cerebrospinal fluid leakage?

Patients without irreversible neurological damage will not experience long-term effects.

Can cerebrospinal fluid leakage recur after treatment?

About 10% of patients may experience spontaneous recurrence.

Do patients need frequent follow-ups after recovery?

If no new symptoms occur, regular medical follow-ups are unnecessary.

DIET & LIFESTYLE

Do patients cured of cerebrospinal fluid leakage still need special care in their daily lives?

Patients without limb movement disorders do not require special daily care.

PREVENTION

How to Prevent Cerebrospinal Fluid Leakage?

There is no specific prevention method for spontaneous cerebrospinal fluid leakage.