A recent incident that grabbed headlines and caught the attention of one and all was when a woman who had to consult several doctors for a constant runny nose and headache, finally discovered that it was actually the cerebrospinal fluid leaking out of her brain that caused the problem.
The 52-year-old woman, a resident of Omaha, had met with a car accident two years ago, when her face banged against the dashboard. Thereafter, she constantly struggled with migraine headaches and a runny nose.
After several visits to various doctors for a diagnosis, she learnt that the actual reason behind her runny nose was a cerebrospinal fluid (CSF) leak, which was caused by a small hole in her skull due to the car crash.
Detailed here are the symptoms and treatment methods of this rare medical condition:
What Is A CSF Leak?
The watery fluid that acts as a cushion protecting the brain and spinal cord is called cerebrospinal fluid (CSF). Although the main function of CSF is to act as a cushion between the brain and skull. It is also a shock absorber for the central nervous system. It helps circulate the nutrients and chemicals in the blood and removes the waste products from the brain.
The fluid can leak through one's nose, ears, or from the head or a spinal cord, in cases of accidents or other trauma. When a CSF leak happens, the cushioning around the brain is reduced, with the brain resting directly on the skull, thereby leading to headaches that can worsen when sitting in an upright position or when standing.
Causes Of CSF Leak:
CSF leak is often caused following an accident. At times, the trigger could be due to straining, certain sporting activities, stretching, roller-coaster rides and falls, etc. Certain head, brain or spinal surgeries, lumbar puncture, or pain medications are other causes. Genetic disorders of the connective tissues or polycystic kidney disease are also some times noticed in these patients. However, a CSF leak without any such causes is called spontaneous CSF leak.
Symptoms Associated With CSF Leak:
• Draining of a clear watery fluid from one side of the ear or nose, particularly when moving or tilting the head
• Vision changes
• Loss of hearing
• Neck pain
• Nausea, vomiting
• Sensitivity to light or sound
• Ringing in the ears
• Metallic taste in the mouth
Treatment For This Condition:
Bed Rest And Hydration
Depending on the cause of the leak, most CSF leaks can heal on their own with complete bed rest and drinking plenty of fluids. The patient is advised sufficient hydration of at least 2 to 3 litres per day. To speed up the healing process, drinking fluids containing caffeine is sometimes recommended, as it can stop and slow the leak and prevent headaches. Headaches are treated with fluids and pain relievers.
Epidural Blood Patching
Despite bed rest if the symptoms persist, an epidural blood patching is advised. This procedure involves injecting the patient's own blood into the spinal canal. When the leak site is known, the injection is given as close to it as possible. But when the leak site is unknown, a high volume blood patch is injected into the lumbar spine. The resulting blood clot acts as a patch on the hole, through which the fluid leaks.
Another method of patching involves injection of fibrin glue at the source of the leak or tear. It is similar to a blood patch and is often used when a blood patch fails. Sometimes, the glue is mixed with blood and injected as a combination patch, when the site of leak is unknown, and only a small area of the spine is suspected.
Meanwhile, if the patient shows any symptoms of an infection such as fever or chills, it is treated with antibiotics.
Rarely, surgery may be required to fix the leak when these conservative methods do not work. During the surgery, a graft material is used to seal the leak. The material so used could be clops, sutures, synthetic sealants or even tissue taken from other parts of the body.
Precautions Following A CSF Leak:
If you have had a CSF leak, which has either resolved on its own, or has required medical intervention, always follow the guidance of the doctor for after-care methods post treatment. As a general precautionary measure, stick to the following:
• Avoid bending, stretching, straining and lifting heavy objects.
• Avoid coughing or sneezing with your nose or mouth closed.
• Avoid excess straining on the toilet, and activities such as blowing up balloons, playing wind instruments, etc.
• Reduce or avoid things that elevate the volume or pressure of the fluid around the brain like salt or caffeine.