A CSF leak is an escape of the fluid that surrounds the brain and spinal cord. This fluid is called the cerebrospinal fluid (CSF).
Intracranial hypotension; Cerebrospinal fluid leak
Any tear or hole in the membrane that surrounds the brain and spinal cord (dura) can allow the fluid that surrounds those organs to leak. When it leaks out, the pressure around the brain and spinal cord drops.
Causes of leakage through the dura include:
Sometimes, no cause can be found. This is called a spontaneous CSF leak.
Symptoms may include:
Exams and Tests
The health care provider will perform a physical exam and ask about your symptoms. Tests may include:
Depending on the cause of the leak, many symptoms improve on their own after a few days. Complete bed rest for several days is usually recommended. Drinking more fluids, especially drinks with caffeine, can help slow or stop the leak and may help with headache pain.
Headache may be treated with pain relievers and fluids. If the headache lasts longer than a week after a lumbar puncture, a procedure may be done to block the hole that may be leaking fluid. This is called a blood patch, because a blood clot can be used to seal the leak. In most cases, this makes symptoms go away. In rare cases, surgery is needed to repair the tear in the dura and stop the headache.
If symptoms of infection (fever, chills, change in mental status) are present, they need to be treated with antibiotics.
Outlook is usually good depending on the cause. Most cases heal by themselves with no lasting symptoms.
If the CSF leak keeps coming back, high pressure of the CSF (hydrocephalus) might be the cause and should be treated.
Complications may occur if the cause is surgery or trauma. Infections after surgery or trauma can lead to meningitis and serious complications, such as swelling of the brain, and need to be treated right away.
When to Contact a Medical Professional
Call your provider if:
Most CSF leaks are a complication of a spinal tap or surgery. The provider should use the smallest needle possible when doing a spinal tap.
Osorio JA, Saigal R, Chou D. Neurologic complications of common spine operations. In: Steinmetz MP, Benzel EC, eds. Benzel's Spine Surgery. 4th ed. Philadelphia, PA: Elsevier; 2017:chap 202.
Rosenberg GA. Brain edema and disorders of cerebrospinal fluid circulation. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 88.
Review Date: 4/30/2018
Reviewed By: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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