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Cerebrospinal Fluid (CSF) Leak

What is Cerebrospinal Fluid (CSF) Leak?

Cerebrospinal fluid is a watery fluid that circulates around the brain and spinal cord. It is usually contained by the meningeal layers, which encase the brain and spinal cord. A flaw in the outer meningeal layer can lead to leakage of cerebrospinal fluid, which may come out through the nose or ears if the leak occurs in the head. This fluid provides cushioning to the brain and its loss can lower the pressure within the skull (intracranial hypotension), causing headaches.


Cerebrospinal fluid (CSF) leakage can be spontaneous with no known cause. The following are some possible common causes:
  • Trauma to the head or spine
  • Lumbar puncture 
  • History of spinal injections or spinal catheters
  • Head or spine surgery
  • Abnormally high CSF in the head(hydrocephalus)
  • Underlying and untreated intracranial hypertension
  • Brain tumours
  • Skull defects that may be present from birth
  • Bone spurs in the spine
  • Certain connective tissue disorders


Cerebrospinal fluid (CSF) leak can cause:
  • Headaches
  • Nasal drainage
  • Meningitis
  • Tinnitus
  • Balance issues
  • Vision changes (blurred vision, double vision, visual field changes)
  • Sensitivity to light
  • Sensitivity to sound
  • Neck stiffness and pain
  • Nausea and vomiting
  • Pain the arm and upper back


Your doctor will discuss your symptoms, check your medical history, and conduct a physical exam. Your nasal fluid will be examined for a protein called beta-2 transferrin which is usually only found in cerebrospinal fluid. Cotton pledgets may be placed in the nose and evaluated for CSF leakage. Your ears will also be examined.
Other diagnostic tests include:
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI)
  • Cisternogram: A CT scan of the nasal structures enhanced by a contrast material which can identify exactly where the CSF leak is and its pathway into the nasal cavity

Treatment for cerebrospinal fluid (CSF) leak

Treatment options for a CSF leak depend on its cause, severity, and location of the leak in the head or spine.

Conservative treatments

Conservative treatment may be recommended first such as:
  • Bed rest 
  • Hydration 
  • IV caffeine infusions
  • Saline infusions
Patients with cranial CSF leaks are instructed to avoid coughing, sneezing, and heavy lifting. Stool softeners are recommended to avoid straining during bowel movements.

Surgical treatments

If conservative treatments are not successful in stopping the leak, more invasive procedures are recommended.
  • Cranial CSF leak: Treatment depends on the size and location of the leak. Leaks through the nasal cavity are often dealt with using nasal endoscopic procedures, while leakage through the ear commonly requires microscopy. A synthetic graft with your own tissue or with glue or bone cement is used to repair the defect. A drain may be placed to decrease intracranial pressure in cases of hydrocephalus.
  • Spinal CSF leak: This is treated using an epidural blood patch, wherein your own blood is injected into the spinal cord area of leakage so that the blood may clot and plug the leak.
  • King's College London
  • Stanford University
  • University of Pittsburgh Medical Center
  • The Royal College of Surgeons of England