How to Recognise a Cerebrospinal Fluid (CSF) Leak and When to Seek Medical Help

A cerebrospinal fluid leak happens when there is a tear or hole in the membranes surrounding the brain or spinal cord, allowing the clear fluid that surrounds and cushions those organs to escape. This leakage can lead to a decrease in pressure around the brain and spinal cord, a condition known as intracranial hypotension, and other various potential symptoms.

Symptoms of a Cerebrospinal Fluid Leak

There are two distinct types of cerebrospinal fluid leaks: spinal cerebrospinal fluid leaks and cranial cerebrospinal fluid leaks. 

Spinal cerebrospinal leaks can occur anywhere along the spinal column, while cranial leaks take place within the skull. Rarely, cranial leaks may result in clear fluid drainage from the nose or ear. Depending on the severity and site of the tear, cerebrospinal fluid leak symptoms may vary, with some posing a risk of life-threatening complications. 

Symptoms from a spinal cerebrospinal fluid leak include:

• A headache that causes pain in the back of the head and improves when lying down
• Neck or shoulder pain
• Nausea or vomiting
• Changes in hearing or ringing in the ears
• Sensitivity to light and/or sound

Symptoms from a cranial cerebrospinal fluid leak include:

• Clear, watery drainage from one side of the nose or ear (Unlike a runny nose, drainage is usually clear and constantly dripping. That said, it may be difficult to distinguish from normal nasal discharge without testing)
• Loss of smell and/or hearing
• A salty or metallic taste in the mouth
• Meningitis (swelling of the protective membranes covering the brain and spinal cord due to an infection)

Generally, cerebrospinal fluid leaks can be treated with a thorough medical evaluation. However, if left untreated, they may lead to severe complications, including life-threatening meningitis.