Cerebrospinal Fluid Leak (CSF)

Your brain and spine are two of the most important parts of your body, which is why you have several protections in place to prevent them from becoming injured.

One of those protections is cerebrospinal fluid (CSF), a watery substance that flows through the hollow spaces surrounding the brain and spine to cushion it from any potential harm.

If this fluid begins to leak because of a hole or tear in the skull or membranes that protect the spine and brain, problems can arise.

At The Ohio State University Wexner Medical Center, we have sinus care experts who can collaborate with neurosurgeons and other specialties to identify whether a CSF leak is causing your symptoms, find where the leak is occurring and fix it.

What is a cerebrospinal fluid leak?

A CSF leak happens when the watery fluid surrounding the brain or spine begins to leak through a tear, puncture or crack in the skull or dura, the outermost membrane that protects the spine and brain.

Leaking spinal fluid can cause a variety of sinus problems and other symptoms and lead to complications, such as meningitis and infections, so it’s important to have it treated.

Types of cerebrospinal fluid leaks

There are two distinct types of CSF leaks, depending on where the leak occurs. Sometime these can have different causes and symptoms. The types of leaks are:

• Cranial cerebrospinal fluid leak – occurring near the brain
• Spinal cerebrospinal fluid leak – occurring near the spine

What causes a cerebrospinal fluid leak?

There are a variety of causes of a cerebrospinal fluid leak, but typically the leak occurs when there is an injury to the head or spine.

Causes of a CFS leak include:

• Injury or trauma to the head
• Brain, spine or skull surgeries
• A lumbar puncture, also called spinal tap or spinal anesthesia (including an epidural)
• Malformations of the inner ear
• Bone spurs on spine
• Buildup of pressure in the brain

The cause is sometimes unknown, which is called a spontaneous cerebrospinal fluid leak.

CFS Leak Symptoms

The symptoms you may feel from a cerebrospinal fluid leak often depend on whether the leak is happening near your spine or brain.

If you have a cranial CSF leak, the most common symptom is drainage of clear, watery fluid from the nostrils, just like a runny nose. The fluid can also come out of the ear.

Other symptoms include:

• Hearing loss
• A salty or metallic taste in mouth (fluid can drain into throat, too)
• Meningitis

The most common symptom of a spinal CSF leak is a headache that gets better when you lay down.

Other symptoms of a spinal cerebrospinal fluid leak include:

• Neck and shoulder pain
• Ringing in ears
• Dizziness
• Nausea
• Vision changes

What’s the difference between a runny nose and a CSF leak?

Both conditions cause a clear liquid to come out of your nose; however, there are a few differences.

Key differences between a runny nose and a cerebrospinal fluid leak are:

• Nasal mucus, or snot, will cause a tissue or handkerchief to stiffen when it dries. Spinal fluid will not.
• Your runny nose might only occur when you have a certain posture, such as bending over. If that’s the case, it’s likely a CSF leak.
• A runny nose gets better over time, even without medical intervention. A CSF leak usually won’t.

Our providers will use a number of tests and tools to accurately identify a CSF leak, since they can be very difficult to diagnose.

Cerebrospinal fluid leak treatments

A CSF leak can cause serious complications, such as brain swelling and meningitis, if the condition is not treated properly.

That’s why it’s important to work with the ENT experts at the Ohio State Wexner Medical Center for your care.

Some cranial leaks, such as the ones caused by injury, might heal themselves within a few days with bed rest, diet protocols and medical monitoring.

However, if it doesn’t heal quickly, we’ll most likely have to intervene with medications, injections or surgical procedures.