CSF leak is an escape of the fluid that surrounds the brain and spinal cord. It protects the brain and spinal cord by acting like a liquid cushion. The fluid allows the organs to be buoyant protecting them from blows or other trauma. Inside the skull the cerebrospinal fluid is contained by the dura which covers the brain. Cerebrospinal fluid is a salty fluid leaking from the nose, especially with exertion or straining. CSF leak can also be caused by a lumbar puncture or by placement of tubes used for epidural anesthesia or pain medications. Causes of CSF include blunt head trauma including neoplasms and empty sella.
CSF otorrhea occurs in the presence of a breached tympanic membrane. Fractures of the petrous temporal bone, translabyrinthine and/or mastoid surgery, developmental defects of the tegmen tympani or petrous apex with meningocele formation and spontaneous or posttraumatic meningeal laceration, perilymphatic fistula from trauma with stapes fracture and torn round or oval window membrane, translabyrinthine fistula due to the Mondini developmental defect of the cochlear modiolus and/or lamina cribrosa, and wide cochlear aqueduct syndrome. CSF rhinorrhea occurs in 2-6% of patients with head injury.
Rhinorrhea or otorrhea happens in up to 30% of patients with a skull-base fracture. Head trauma accounts for 50-80% of all cases of CSF leak, and up to 16% are iatrogenic. CSF leak resulting from trauma occurs usually with fractures of ethmoid, sphenoid, or petrous temporal bones. Symptoms usually include a headache that is worse with sitting up and improves when you lay down. Leakage of CSF from a tear of the dura in the head can also cause a runny nose. Treatment of Cerebrospinal fluid leak depend on the cause, many cases go away on their own after a few days. Complete bed rest for several days is usually recommended.
Antibiotic therapy is also required when you suffer fever, chills, change in mental status. Headache may be treated with pain relievers and fluids. If the headache persists longer than a week after a lumbar puncture, a procedure may be done to block the hole that may be leaking fluid. Cervical or thoracic spinal CSF fistulas are sometimes effectively treated by using a lumbar blood patch. Measures such as wearing a helmet when riding a bicycle or motorcycle can help prevent head injuries that can lead to CSF leak. When you riding a bicycle or motorcycle wearing a helmet can can help prevent head injuries that can lead to CSF leak.