Cerebrospinal Fluid (CSF) Leak: Causes, Symptoms & Treatment

CSF leak = dural tear allowing CSF escape into soft tissue or vascular space.

Causes

• Trauma (head/spine fracture, basilar skull fracture)
• Iatrogenic (neurosurgery, lumbar puncture, epidural)
• Spontaneous (connective tissue disorders, high ICP)
• Tumors (erosion)
• Infection (meningitis)

Symptoms

• Positional headache: Worse upright, better supine (classic).
• Clear otorrhea/rhinorrhea (cranial leaks).
• Nausea, photophobia, neck stiffness, tinnitus, hearing change.
• Neurologic deficits if compressive.

Diagnosis

• Beta-2 transferrin assay (specific for CSF).
• CT myelography, MR cisternography, radionuclide cisternography.

Treatment

• Conservative: bed rest, hydration, caffeine, lumbar drain.
• Surgical: dural repair (endoscopic, open).
• Epidural blood patch (for post-LP leaks).

Untreated leaks risk meningitis, pneumocephalus.