Surgical repair may be performed in patients with failed epidural blood patches if the site of the leak has been identified.Blood patches are generally thought to be safe but occasional reports of increased CSF pressure and persistent epidural fluid collections have been reported. An epidural blood patch is used in patients with spinal leaks who fail noninvasive measures.The pattern of hearing loss may resemble that of Meniere’s disease. Hearing testing is sometimes affected by CSF-leak.Spinal fluid testing with a beta-trace protein assay.Head or spine MRI to detect evidence of sinking of the brain, collapse of the superior opthalmic vein, subdural fluid collection, decrease in ventricular size and prominent dural sinuses, extra-arachnoid fluid, meningeal diverticuli, meningeal enhancement, or engorgement of epidural venous plexi.Head CT with reconstructive views to view skull base fracture anatomy.Tests not requiring lumbar puncture include: This study is somewhat invasive, requiring injection of material into the spinal canal. Radioisotope cisternography characteristically shows a decrease or absence of activity over the cerebral convexities and early accumulation of radioisotope in the bladder.Radiologic studies are also useful however, they may be impractical if one does not know the level of the leak.Radioactive label or a fluorescent dye injected into the spinal fluid to test for the label or dye in the fluid.There is some danger of exacerbating an existing leak or causing a new one leak with a lumbar puncture, and the risks/benefits must be carefully considered. In this situation, leaks may recur until the cerebral ventricles are shunted. Other conditions to exclude when considering the diagnosis of CSF leak are orthostatic hypotension (which can cause dizziness on standing), positional vertigo due to inner ear disturbances, and orthostatic tremor.ĬSF leaks can also result from high-pressure hydrocephalus. CSF leaks have been reported due to cervical bone spurs. Speculatively, it would seem possible that CSF leaks might occur after whiplash injury, as frequently there are persistent similar symptoms without findings on other studies. Spontaneous leaks from the nose are uncommon. In this case, the leak is at the site of the puncture. CSF leaks can also occur in the nose after trauma or surgery.ĬSF leaks may follow diagnostic or therapeutic lumbar puncture as well as spinal anesthesia and after an inadvertent puncture of the dura following epidural anesthesia or epidural steroid injections. Sometimes they are unintentional consequences of an overdraining CSF shunt, placed for CSF hypertension. Spontaneous leaks are most commonly at the level of the spine, particularly the thoracic spine and cervicothoracic junction. Traumatic CSF leaks are usually present following basilar skull fractures with either leakage from the nose (rhinorrhea) or ear (otorrhea). It seems likely that these cases are often missed. Symptoms from the leak can be delayed for as long as a month. These symptoms are rather nonspecific as they are commonly encountered in migraine and post-traumatic headache. Change in hearing (hearing loss of CSF leak likely results from lowering of CSF pressure, which lowers inner ear pressure).Headaches, which are more severe in the upright position and are alleviated by lying down with the head lower than the chest.Spinal CSF Leak Canada makes no representations or warranties with respect to any information offered or provided on this website and is not liable for any direct or indirect claim, loss or damage resulting from use of this website and/or any website(s) linked to/from it.Cerebrospinal fluid (CSF) depletion may be caused by a leak, a shunt, inadequate production or too-rapid absorption. Any action on your part in response to the information provided in this website is at the reader’s discretion. You should consult a physician or other healthcare provider in all matters relating to your health, and particularly in respect to any symptoms that may require diagnosis or medical attention. You should not use the information on this website for diagnosing or treating a medical or health condition. This information does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. The information on this site is not a substitute for professional medical advice. All information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes.
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