A cerebralspinal fluid leak, also known as a CSF leak, is a serious complication of a head injury. This typically occurs when there is a hole in the skull, such as a fracture. This potentially life-threatening injury has to be recognized as quickly as possible to prevent the leak from resulting in brain death.
What's interesting about CSF leaks is that they are not always caused by injuries. For this article, the type of CSF leak is one caused by an injury to the skull.
What happens when you suffer an injury to the skull?
Depending on the severity of the break, cerebralspinal fluid may or may not leak from the skull. It's most common to see the CSF leak with a head injury, though. Symptoms often include noticing watery drainage from the nose or ears. Usually, the leak occurs on only one side or through the nose, not all locations. Other symptoms that occur alongside a CSF leak include:
- Increased drainage when tilting the head
- Impaired or a loss of hearing
- Vision changes
How does a medical provider diagnose a CSF leak?
Initially, a medical provider has to complete a physical exam. They might ask a patient to lean to one direction or another to see if it increases drainage. CT scans and MRIs are also used to identify a broken skull or other defects. In the case that the drainage can be collected, it is collected and sent for testing.
Once the CSF leak diagnosis is made, the treatment options vary. A serious leak requires surgical intervention. For patients who don't need surgery, they are told to avoid movements such as sneezing or heavy lifting. Normally, they require between one and two weeks of bed rest as the skull bone begins to heal.
When a conventional treatment like above doesn't work, patients have to go the surgical route. The provider may choose endoscopic surgery or an external incision surgery to locate the open wound and close it with graft material. After a week, any nasal packing used is removed postoperatively, so the patient can once again use the nasal passages normally.
Any kind of CSF leak is serious for a patient. There is a risk of brain herniation, infection and decreased pressure in the brain, which can all lead to serious complications. Patients require immediate care if it appears there is a CSF leak for any reason.