Is your Cerebrospinal Fluid Leaking?

When a traumatic event is sustained by the body, sometimes a cerebrospinal fluid leak can occur. The hallmark signs of these types of leaks are orthostatic symptoms and severe general debilitation. Orthostatic symptoms are symptoms that change with the position of the body. In the case of a CSF leak, these are headaches, fatigue, and achiness after some amount of time moving around.  A Cerebrospinal Fluid (CSF) Leak is a leak of the fluid that surrounds the brain and spinal cord into the surrounding tissues. This can happen after severe trauma, a lumbar puncture, or spinal anesthesia especially in people who have generalized ligament laxity, hypermobility, or even Ehler’s Danlos Syndrome (EDS).

Symptoms of a Cerebrospinal Fluid Leak:

The main feature of a spinal fluid leak is severe debilitation which is generally better when laying down. All of a person’s symptoms get worse the longer that they are upright (termed Orthostatic symptoms; for example, an orthostatic headache would be one that gets worse when upright and during exertion and gets better when someone lays down). When the leak is in the skull somewhere, persistent rhinorrhea aka a runny nose can happen as well. Migraines are a common symptom caused by cerebrospinal fluid leaks.

Diagnosis of a Cerebrospinal Fluid Leak:

The diagnosis is based on the patient’s history. The next step in the diagnosis can be an analysis of nasal secretions if that is part of the clinical picture. The nasal secretions are analyzed, looking for a certain protein called Beta-transferrin which is only found in cerebrospinal fluid and not in normal nasal secretions.

If the leak is suspected to be below the neck (symptoms starting after a lumbar puncture or some kind of trauma to the spine), then most commonly a blind blood patch will be performed as a diagnostic treatment. Blood is drawn from the patient and injected into the spinal canal via a lumbar puncture. The blood moves through the CSF and clots to patch the hole that the fluid is leaking through. If this improves the patient’s symptoms, then we know that there is a leak somewhere. Blood patches don’t always last though because they can become dislodged after a forceful sneeze, re-injury of the area, etc.

 

To learn more about CSF leaks, this video is quite informative.