Diagnosis

Spinal CSF leak

Your doctor will likely start with your medical history and a physical exam. The flexibility of your joints also may be checked.

Tests to diagnose a spinal CSF leak may include:

  • MRI with gadolinium. This imaging test uses a contrast agent, gadolinium, to better highlight abnormalities in the brain or spine that result from a CSF leak.
  • Radioisotope cisternography. This test involves measuring the CSF pressure and then injecting a chemical into the space surrounding the spinal cord. Then, images of the area are taken several times within a 24-hour period. These images track the flow of CSF, which will be abnormal if there is an active spinal CSF leak.
  • Myelography. This test is considered the gold standard for diagnosing and locating CSF leaks. It uses digital subtraction fluoroscopy, a CT or MRI scan, and a contrast dye to locate CSF leaks. It provides the most precise location of a CSF leak and helps to determine the most appropriate treatment plan.
  • Spinal tap (lumbar puncture). This test involves placing a needle in the spinal column to measure the pressure of CSF inside the spinal column, though pressure is normal in more than half of patients with spinal CSF leaks.

Cranial CSF leak

Your doctor will likely start with your medical history and a physical exam, including close evaluation of your nose and ears. You may be asked to lean forward to check for any nasal discharge, which may be collected and sent to a lab for testing.

Tests to diagnose a cranial CSF leak may include:

  • MRI with gadolinium. This imaging test uses a contrast agent, gadolinium, to better highlight abnormalities in the brain to locate the source of a CSF leak.
  • Tympanometry. Your middle ear fluid may be tested to check for CSF.
  • CT myelography. This test is considered the gold standard for diagnosing and locating CSF leaks. It uses a CT scan and a contrast dye to locate CSF leaks anywhere in the skull base. It provides the most precise location of a CSF leak and helps to determine the most appropriate treatment plan. High-resolution CT (HRCT), which provides images in even greater detail, also may be used.

Treatment

Some CSF leaks improve with bed rest alone. Other CSF leaks may need treatment.

Treatments for spinal CSF leaks may include:

  • Epidural blood patch. This treatment involves taking a sample of your own blood, then injecting it into the spinal canal. The blood cells form a clot, which creates a patch to cover the area where the CSF is leaking.
  • Sealant. A special sealant may be used alone or mixed with your blood in the same technique described above to cover the hole and stop the CSF leak.
  • Surgery. Some CSF leaks need surgery, though surgery is only performed if the other treatment options don't work and the precise site of the leak is known. There are several types of surgical treatments that repair CSF leaks. Surgery may involve repairing the CSF leak with stitches or grafts made from patches of muscle or fat.
  • Trans-venous embolization. This is a new minimally invasive, catheter-based treatment for CSF-venous fistulas only that involves gluing shut the fistula from inside the culprit vein.

Some cranial CSF leaks, such as those caused by trauma, improve with conservative measures such as:

  • Bed rest
  • Elevating the head of the bed
  • Taking stool softeners to prevent straining

Most spontaneous cranial CSF leaks require surgery.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Preparing for your appointment

After discussing your symptoms with your family doctor, he or she might refer you to a doctor trained in brain and spine conditions (neurologist, neurosurgeon, ENT) for further evaluation.

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

  • Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began
  • Key personal information, including major stresses or recent life changes
  • All medications, vitamins or other supplements you take, including doses
  • Questions to ask your doctor

Bring with you to the appointment recent test results and scans of your brain and spine. Take a family member or friend along, if possible, to help you remember the information you receive.

For CSF leaks, questions to ask your doctor include:

  • What is likely causing my symptoms or condition?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What is the best course of action?
  • Would losing weight help my condition?
  • I have these other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Should I see a specialist?
  • Are there brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

CSF leak (Cerebrospinal fluid leak) care at Mayo Clinic

Oct. 26, 2021
  1. Spinal cerebrospinal fluid leak. AskMayoExpert. Mayo Clinic; 2021.
  2. Sun-Edelstein C, et al. Spontaneous intracranial hypotension: Pathophysiology, clinical features and diagnosis. https://www.uptodate.com/contents/search. Accessed July 20, 2021.
  3. Sun-Edelstein C, et al. Spontaneous intracranial hypotension: Treatment and prognosis. https://www.uptodate.com/contents/search. Accessed July 20, 2021.
  4. Cranial/base of skull CSF leak. AskMayoExpert. Mayo Clinic; 2021.
  5. Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA. 2006; doi: 10.1001/jama.295.19.2286.
  6. Jankovic J, et al. Headache and other craniofacial pain. In: Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed July 28, 2021.
  7. Nagel SJ, et al. Cerebrospinal fluid disorders and transitional neurosurgery. In: Youmans and Winn Neurological Surgery. 7th ed. Elsevier; 2017. https://www.clinicalkey.com. Accessed July 28, 2021.
  8. Chan SM, et al. Intracranial hypotension and cerebrospinal fluid leak. Neuroimaging Clinics of North America. 2019; doi:10.1016/j.nic.2019.01.002.
  9. Braswell-Pickering B. Allscripts EPSi. Mayo Clinic. August 9, 2021.

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