Spinal Fluid Leak: Symptoms, Causes and Treatment

Overview

Spinal Fluid Leak is an escape of the fluid that surrounds the brain and spinal cord. This fluid is called the cerebrospinal fluid (CSF). The brain and spinal cord are surrounded by three protective membranes. The outer one is called the dura. One function of the dura is to contain the cerebrospinal fluid – the liquid that bathes and cushions the brain and spinal cord.

Spinal CSF leaks develop due to tears in the soft tissues surrounding the spinal cord. This fluid can either drain from the ear or the nose, depending on where the skull bone is damaged.

It is estimated that CSF leaks have an incidence of about 5/100,000 per year.

Causes

Any tear or hole in the membrane that surrounds the brain and dura can allow the fluid that surrounds these organs to leak. In some cases, spinal fluid leak occurs spontaneously and the cause is unknown, which is called “idiopathic” spinal fluid leaks.

Others may be caused by trauma such as a head injury, brain or spinal surgery, an epidural, a lumbar puncture or a skull base tumor. Besides, some leaks are due to a congenital defect in the dura. Congenital and idiopathic spinal fluid leaks are most common in the upper and middle spine.

People with high-pressure hydrocephalus or an abnormal accumulation of cerebrospinal fluid may be at an increased risk of suffering from spinal fluid leaks.

Symptoms

The most common symptom of the spinal fluid leak is a different degree of headache. Other possible symptoms include:

  • Positional headaches, which may get worse when sitting upright or lying down
  • Nausea and vomiting
  • Nasal drainage
  • Neck pain or stiffness
  • Change in hearing (muffled, ringing in the ears)
  • Sense of imbalance
  • Sensitivity to light or sound
  • Pain between the shoulder blades
  • Facial pain

Diagnosis

To diagnose spinal fluid leak, the doctor will first perform a physical evaluation and conduct a thorough medical history. After that, one or more of the following tests may be taken to check CSF pressure and to confirm spinal fluid leak along the spine or base of the skull.

  • CT Myelogram: It will use a contrast to inject into the spinal fluid through a spinal tap under CT fluoroscopic guidance and then performing CT scans. This test identifies the exact location of the CSF leak.

  • Magnetic Resonance (MR) Myelography: This can be performed to look for signs of a leak without any intervention. It can also be performed to find a leak that has not been detected by CT. This may require the injection of MR contrast into the spinal sac before imaging.

  • MRI of the Brain: This can reveal brain abnormalities that may indicate CSF fluid loss. It should include sagittal images of the brain. A small percentage of people with CSF leaks have a normal MRI of the brain, so additional imaging test is often needed.

Treatment

Treatment
for spinal fluid leak varies on the type and severity of the symptoms. Conservative
treatment is usually recommended first in cases of spontaneous CSF leak or head
trauma. This includes 1-2 weeks of bed rest. Common treatments are as follows:

  • Blood Patch

For patients
with spinal CSF leaks that do not respond to bed rest and other conservative
treatments, an epidural blood patch is a treatment option. An epidural blood
patch involves injecting the patient’s own blood into the spinal canal. The
resulting blood clot will “patch” the hole where the leak is
occurring. If the precise location isn’t known, one or more patches may be
placed. This procedure is performed with moderate sedation.

  • Disc Surgery

If
the leak is caused by the sharp edge of a spinal disc rubbing against the dura,
a disc surgery can be used to stop the friction and repair the leak by shaving
off the sharp edge and wrapping the dura with collagen fiber.

  • Venous Fistula Surgery

Sometimes
a leak of cerebrospinal fluid occurs due to CSF draining too quickly into the
venous system. To regulate the loss of fluid, a venous fistula surgery will be
taken to wrap or clip the vein at a nerve root and remove adjacent veins.

Before taking any treatment options, please ask a doctor for more detailed and correct advice.



Keywords: spinal fluid leak.

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