Materiały źródłowe

• #1 Cerebrospinal Fluid Leak – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538157/

  Cerebrospinal fluid (CSF) is a clear protein- and glucose-rich liquid in the subarachnoid space of the central nervous system. […] A leak in this system, therefore, can be detrimental to brain blood supply and function and can increase the risk of direct trauma to brain parenchyma due to loss of fluid cushion. […] Additionally, the presence of a CSF leak indicates the need for further evaluation and management, as it may be due to a frontobasilar or temporal skull fracture. […] This activity reviews the etiology, presentation, evaluation, and management of CSF leaks and reviews the role of the interprofessional team in evaluating, diagnosing, and managing the condition. […] Review the appropriate steps in a workup and evaluation of a suspected CSF fluid leak. […] The CSF leak occurs when there is a tear or hole in the dura mater, the outermost layer of the meninges that protect the central nervous system, communicating the subarachnoid space with the epidural space and, sometimes, with the skin establishing a connexion between the CNS and the external environment.

• #2 Cerebrospinal Fluid (CSF) Leak | Choose the Right Test

  https://arupconsult.com/content/csf-leak-beta-2-transferrin

  Cerebrospinal fluid (CSF) leaks (also known as CSF fistulas) result from dura mater defects or tears that enable CSF to escape containment. CSF leaks may be spinal or cranial. Tears in the dura mater primarily arise from craniofacial trauma or after procedures such as endoscopic sinus surgery and lumbar puncture. CSF leaks can also occur spontaneously, or in relation to infection, hydrocephalus, congenital malformations, or neoplasms. The most severe consequences of a CSF leak are brain abscess or bacterial meningitis due to the passage of bacteria into craniospinal spaces. Early diagnosis and intervention, particularly in the case of cranial CSF leaks, are critical to prevent these outcomes. […] Diagnosis of cranial leaks can be challenging in outpatient and postsurgical contexts, in part because such leaks can be difficult to distinguish from chronic rhinitis. Beta-2 transferrin testing is the preferred laboratory approach to assess patients for cranial CSF leaks because it is highly specific and sensitive for CSF secretions.

• #3 Diagnosis of Spinal CSF leak – Diagnosis – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/about-spinal-csf-leaks/diagnosis-of-spinal-csf-leak/

  Recognizing and diagnosing spinal CSF leak can be challenging, largely due to low familiarity on the part of health care professionals. […] The most important clues to the diagnosis of intracranial hypotension lie in the patient history. […] The hallmark symptom is head pain that is worse when upright and improved with horizontal positioning. […] Lumbar punctures, epidural injections and spinal surgery occurring prior to onset of symptoms may be responsible for a spinal CSF leak. […] Spinal CSF leaks that develop spontaneously or with minimal precipitant may be related to an underlying weakness of the spinal dura. […] Spontaneous leaks are also associated with calcified discs or bone spurs that may or may not be known prior to the onset of symptoms. […] Misdiagnosis and delayed diagnosis of spinal CSF leak remain common, largely due to low familiarity by health care professionals, as we see with all uncommonly recognized disorders.

• #4 CSF leak (Cerebrospinal fluid leak) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/csf-leak/symptoms-causes/syc-20522246

  Cerebrospinal fluid (CSF) surrounds the brain and spinal cord and provides a cushion to protect them from injury. When there is a hole or tear in the outermost layer, a CSF leak occurs. The hole or tear in this outer layer, called the dura mater, allows some of the fluid to escape. […] There are two distinct types of CSF leaks: spinal CSF leaks and cranial CSF leaks. Each type has different symptoms, causes and treatments. […] A spinal CSF leak occurs anywhere in the spinal column. The most common symptom of a spinal CSF leak is a headache. […] A cranial CSF leak occurs in the skull, and often causes symptoms such as clear fluid leaking from the nose or ear. […] Some CSF leaks may heal with bed rest and other conservative treatment. Many CSF leaks need a patch to cover the hole or surgery to repair the leak.

• #5 CSF leak (Cerebrospinal fluid leak) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/csf-leak/symptoms-causes/syc-20522246

  Symptoms vary between spinal and cranial CSF leaks. […] The most common symptom of a spinal CSF leak is a headache. […] Other symptoms of spinal CSF leaks may include: neck or shoulder pain, ringing in the ears, changes in hearing, dizziness, nausea or vomiting, changes in vision, changes in behavior or ability to think clearly. […] Cranial CSF leak symptoms may include: clear, watery drainage from one side of the nose or ear, hearing loss, a metallic taste in the mouth, meningitis. […] When there is no surgery or procedure prior to the start of a CSF leak, it is called a spontaneous CSF leak. […] If a cranial CSF leak is left untreated, complications may occur. Possible complications include meningitis and tension pneumocephalus, which is when air enters the spaces surrounding the brain. Untreated spinal CSF leaks may lead to subdural hematomas, or bleeding on the surface of the brain.

• #6 Cerebrospinal Fluid Leak: Symptoms, Diagnosis and Treatment

  https://airomedical.com/blogs/disease-guides/cerebrospinal-fluid-leak-guide

  Various medical conditions might lead to a cerebrospinal fluid leak. […] Doctors worldwide decided to separate the range of cases into four main categories of cerebrospinal fluid leaks: Traumatic, Congenital, Spontaneous. […] For instance, up to 60% of all traumatic brain fluid leaks occur after 3-4 days since the primary trauma and considering acute. […] Patients with neurosurgical conditions such as pseudo meningocele and hydrocephalus have 18,7 times more likely to develop a cerebrospinal fluid leak. […] In most cases, patients with a leak show only symptoms related to the primary disease combined with the leak of a colorless, clear fluid from the ear, nose, or wound. […] Medical practitioners usually use various lab tests to determine cerebrospinal fluid. […] The CSF leak test variety includes: Lab tests, Medical imaging, Myelography.

• #7 Diagnosis of Spinal CSF leak – Diagnosis – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/about-spinal-csf-leaks/diagnosis-of-spinal-csf-leak/

  Recognizing and diagnosing spinal CSF leak can be challenging, largely due to low familiarity on the part of health care professionals. […] The most important clues to the diagnosis of intracranial hypotension lie in the patient history. […] The hallmark symptom is head pain that is worse when upright and improved with horizontal positioning. […] Lumbar punctures, epidural injections and spinal surgery occurring prior to onset of symptoms may be responsible for a spinal CSF leak. […] Spinal CSF leaks that develop spontaneously or with minimal precipitant may be related to an underlying weakness of the spinal dura. […] Spontaneous leaks are also associated with calcified discs or bone spurs that may or may not be known prior to the onset of symptoms. […] Misdiagnosis and delayed diagnosis of spinal CSF leak remain common, largely due to low familiarity by health care professionals, as we see with all uncommonly recognized disorders.

• #8 Diagnosis of a CSF Leak | CSF Leak Association

  https://csfleak.uk/resource/diagnosis-of-csf-leak

  There are many ways to diagnose a CSF Leak including investigative techniques and medical imaging. If a CSF Leak is suspected, the next step is to identify where the leak is so that an appropriate treatment can be planned. […] Where a CSF Leak is suspected as a result of symptoms or patient history, establishing the precise location of the leak is generally the next step. […] A variety of imaging techniques, scans and investigations can be undertaken to determine where CSF is leaking some are more successful than others. […] Even where scans are unable to locate a leak site, they may be able to disclose the symptoms that help to confirm diagnosis, such as intracranial hypotension with spinal leaks (e.g. brain sag or pachymeningeal enhancement), or identify pockets of cerebrospinal fluid outside the dura mater.

• #9 Why Does a Cerebrospinal Fluid (CSF) Leak Cause a Headache?

  https://www.healthline.com/health/csf-leak-headache

  Headaches are among the most common symptoms of a cerebrospinal fluid (CSF) leak. They may develop due to nerve irritation in your meninges. […] Headaches caused by CSF leaks usually worsen when you’re upright and improve when you lie down. […] Headaches may occur in more than 90% of people with CSF leaks. The hallmark symptom is an orthostatic headache. […] An orthostatic headache is a headache that’s worse when you’re vertical and improves when you’re lying down. It usually occurs or worsens within 15 minutes of standing or sitting upright. […] A CSF leak requires emergency medical attention. […] If your doctor suspects a CSF leak, they can have you get imaging such as MRI, CT scan, CT cisternography, or myelogram. […] The average time from first symptoms to diagnosis of a cerebrospinal fluid leak is 2 1/2 months. […] You can’t diagnose a CSF leak at home. […] Most CSF leaks are treatable. But go to the emergency room (ER) for proper evaluation and management if you have possible symptoms. […] Getting immediate medical attention is essential if you think you may have symptoms of a CSF leak.

• #10 Diagnosis of Spinal CSF leak – Diagnosis – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/about-spinal-csf-leaks/diagnosis-of-spinal-csf-leak/

  Recognizing and diagnosing spinal CSF leak can be challenging, largely due to low familiarity on the part of health care professionals. […] The most important clues to the diagnosis of intracranial hypotension lie in the patient history. […] The hallmark symptom is head pain that is worse when upright and improved with horizontal positioning. […] Lumbar punctures, epidural injections and spinal surgery occurring prior to onset of symptoms may be responsible for a spinal CSF leak. […] Spinal CSF leaks that develop spontaneously or with minimal precipitant may be related to an underlying weakness of the spinal dura. […] Spontaneous leaks are also associated with calcified discs or bone spurs that may or may not be known prior to the onset of symptoms. […] Misdiagnosis and delayed diagnosis of spinal CSF leak remain common, largely due to low familiarity by health care professionals, as we see with all uncommonly recognized disorders.

• #11 CSF leak (Cerebrospinal fluid leak) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/csf-leak/symptoms-causes/syc-20522246

  Symptoms vary between spinal and cranial CSF leaks. […] The most common symptom of a spinal CSF leak is a headache. […] Other symptoms of spinal CSF leaks may include: neck or shoulder pain, ringing in the ears, changes in hearing, dizziness, nausea or vomiting, changes in vision, changes in behavior or ability to think clearly. […] Cranial CSF leak symptoms may include: clear, watery drainage from one side of the nose or ear, hearing loss, a metallic taste in the mouth, meningitis. […] When there is no surgery or procedure prior to the start of a CSF leak, it is called a spontaneous CSF leak. […] If a cranial CSF leak is left untreated, complications may occur. Possible complications include meningitis and tension pneumocephalus, which is when air enters the spaces surrounding the brain. Untreated spinal CSF leaks may lead to subdural hematomas, or bleeding on the surface of the brain.

• #12 CSF leak (Cerebrospinal fluid leak) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/csf-leak/symptoms-causes/syc-20522246

  Symptoms vary between spinal and cranial CSF leaks. […] The most common symptom of a spinal CSF leak is a headache. […] Other symptoms of spinal CSF leaks may include: neck or shoulder pain, ringing in the ears, changes in hearing, dizziness, nausea or vomiting, changes in vision, changes in behavior or ability to think clearly. […] Cranial CSF leak symptoms may include: clear, watery drainage from one side of the nose or ear, hearing loss, a metallic taste in the mouth, meningitis. […] When there is no surgery or procedure prior to the start of a CSF leak, it is called a spontaneous CSF leak. […] If a cranial CSF leak is left untreated, complications may occur. Possible complications include meningitis and tension pneumocephalus, which is when air enters the spaces surrounding the brain. Untreated spinal CSF leaks may lead to subdural hematomas, or bleeding on the surface of the brain.

• #13 CSF leak (Cerebrospinal fluid leak) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/csf-leak/symptoms-causes/syc-20522246

  Symptoms vary between spinal and cranial CSF leaks. […] The most common symptom of a spinal CSF leak is a headache. […] Other symptoms of spinal CSF leaks may include: neck or shoulder pain, ringing in the ears, changes in hearing, dizziness, nausea or vomiting, changes in vision, changes in behavior or ability to think clearly. […] Cranial CSF leak symptoms may include: clear, watery drainage from one side of the nose or ear, hearing loss, a metallic taste in the mouth, meningitis. […] When there is no surgery or procedure prior to the start of a CSF leak, it is called a spontaneous CSF leak. […] If a cranial CSF leak is left untreated, complications may occur. Possible complications include meningitis and tension pneumocephalus, which is when air enters the spaces surrounding the brain. Untreated spinal CSF leaks may lead to subdural hematomas, or bleeding on the surface of the brain.

• #14 CSF leak (Cerebrospinal fluid leak) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/csf-leak/symptoms-causes/syc-20522246

  Symptoms vary between spinal and cranial CSF leaks. […] The most common symptom of a spinal CSF leak is a headache. […] Other symptoms of spinal CSF leaks may include: neck or shoulder pain, ringing in the ears, changes in hearing, dizziness, nausea or vomiting, changes in vision, changes in behavior or ability to think clearly. […] Cranial CSF leak symptoms may include: clear, watery drainage from one side of the nose or ear, hearing loss, a metallic taste in the mouth, meningitis. […] When there is no surgery or procedure prior to the start of a CSF leak, it is called a spontaneous CSF leak. […] If a cranial CSF leak is left untreated, complications may occur. Possible complications include meningitis and tension pneumocephalus, which is when air enters the spaces surrounding the brain. Untreated spinal CSF leaks may lead to subdural hematomas, or bleeding on the surface of the brain.

• #15 CSF leak (Cerebrospinal fluid leak) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/csf-leak/symptoms-causes/syc-20522246

  Symptoms vary between spinal and cranial CSF leaks. […] The most common symptom of a spinal CSF leak is a headache. […] Other symptoms of spinal CSF leaks may include: neck or shoulder pain, ringing in the ears, changes in hearing, dizziness, nausea or vomiting, changes in vision, changes in behavior or ability to think clearly. […] Cranial CSF leak symptoms may include: clear, watery drainage from one side of the nose or ear, hearing loss, a metallic taste in the mouth, meningitis. […] When there is no surgery or procedure prior to the start of a CSF leak, it is called a spontaneous CSF leak. […] If a cranial CSF leak is left untreated, complications may occur. Possible complications include meningitis and tension pneumocephalus, which is when air enters the spaces surrounding the brain. Untreated spinal CSF leaks may lead to subdural hematomas, or bleeding on the surface of the brain.

• #16 Cerebrospinal Fluid Leaks ENT Treatment in Utah – ENT Center of Utah

  https://entcenterutah.com/adult-care/sinus/cerebrospinal-fluid-leaks/

  Cerebrospinal Fluid Leaks […] Initially, up to 94% of CSF leaks are misdiagnosed. False diagnoses include sinusitis, meningitis, rhinitis, allergies, migraines, and sinus headache. Typical symptoms include a colorless fluid escaping from the nose (often from only one nostril but can be both sides), headache that feels more painful when upright and improved when lying flat (but other patterns do happen), neck pain or stiffness, stomach irritation and vomiting, a feeling of imbalance, an alteration in hearing, as well as changes in cognition (brain fog) and dizziness. […] The most typical tests used for diagnosing CSF leak are done through an examination from an ear, nose and throat (ENT) specialist. The ENT will most likely use nasal endoscopy, CT and MRI imaging techniques, as well as chemical tests of the liquid that is escaping (beta 2 transferrin test).

• #17 CSF leak (Cerebrospinal fluid leak) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/csf-leak/symptoms-causes/syc-20522246

  Symptoms vary between spinal and cranial CSF leaks. […] The most common symptom of a spinal CSF leak is a headache. […] Other symptoms of spinal CSF leaks may include: neck or shoulder pain, ringing in the ears, changes in hearing, dizziness, nausea or vomiting, changes in vision, changes in behavior or ability to think clearly. […] Cranial CSF leak symptoms may include: clear, watery drainage from one side of the nose or ear, hearing loss, a metallic taste in the mouth, meningitis. […] When there is no surgery or procedure prior to the start of a CSF leak, it is called a spontaneous CSF leak. […] If a cranial CSF leak is left untreated, complications may occur. Possible complications include meningitis and tension pneumocephalus, which is when air enters the spaces surrounding the brain. Untreated spinal CSF leaks may lead to subdural hematomas, or bleeding on the surface of the brain.

• #18 CSF Leak – SinusHealth | CSF Leak Symptoms and Causes

  https://sinushealth.com/conditions/csf-leak/

  CSF leaks usually show up as clear, watery drainage from one side of the nose. […] A history of head injury, head or brain surgery, or previous brain infection can suggest a diagnosis of CSF leak. […] Several lab and imaging tests can help diagnose a CSF leak. […] A sample of nasal drainage can be sent to the lab to look for this protein. Beta-2 transferrin is very accurate and the best lab test for diagnosing a CSF leak. […] Different kinds of imaging can be used to help diagnose CSF leaks. A detailed CT scan is often the first choice and is very good at showing holes, tumors, or other problems in the skull that can cause CSF to drip through the nose. […] Occasionally, special tests known as cisternograms may be needed to determine if a CSF leak is happening. […] There are many causes of CSF leaks, and diagnosis can involve talking with your doctor, lab tests, and imaging studies.

• #19 CSF leak (Cerebrospinal fluid leak) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/csf-leak/symptoms-causes/syc-20522246

  Symptoms vary between spinal and cranial CSF leaks. […] The most common symptom of a spinal CSF leak is a headache. […] Other symptoms of spinal CSF leaks may include: neck or shoulder pain, ringing in the ears, changes in hearing, dizziness, nausea or vomiting, changes in vision, changes in behavior or ability to think clearly. […] Cranial CSF leak symptoms may include: clear, watery drainage from one side of the nose or ear, hearing loss, a metallic taste in the mouth, meningitis. […] When there is no surgery or procedure prior to the start of a CSF leak, it is called a spontaneous CSF leak. […] If a cranial CSF leak is left untreated, complications may occur. Possible complications include meningitis and tension pneumocephalus, which is when air enters the spaces surrounding the brain. Untreated spinal CSF leaks may lead to subdural hematomas, or bleeding on the surface of the brain.

• #20 Cerebrospinal Fluid Leak | UCI Health | Orange County, CA

  https://www.ucihealth.org/medical-services/ear-nose-throat-ent/nose-sinus-disorders/csf-leak

  Cerebrospinal fluid (CSF) is a colorless fluid that cushions the brain, protecting it from trauma and infections. The diagnosis can be difficult to make because nasal drainage is also caused by allergies, sinusitis, and other inflammatory conditions. […] The most common symptoms of CSF leak include steady drip of clear fluid from the nose (typically just one side) and headaches. […] Some patients have already had a recent prior episode of meningitis at the time of evaluation, which increases the suspicion of CSF leak even when the specific location is uncertain. A complete evaluation including a medical history and examination are first performed. You may be asked to collect, if possible, a sample of the fluid in a sterile container to so it can be tested to confirm the leak. A CT scan and/or MRI of the sinuses are often recommended to help identify the exact location of the defect responsible for the leak and assist with planning of the repair.

• #21

  https://umiamihealth.org/en/treatments-and-services/ear,-nose,-and-throat-(ent)/sinus-and-allergy/cerebrospinal-fluid-leaks-(cfs)

  Cerebrospinal fluid (CSF) is a liquid contained within the lining around the brain, called the dura. When there is a hole in the dura and bone, separating the brain from the sinuses, CSF can leak into the sinuses. This can cause clear, water-like fluid drainage from the nose or into the back of the throat. If the CSF drains out of the nose, it is usually from one side. If it drains into the throat, it has been described as salty tasting. […] If a CSF leak is suspected, your ENT specialist will likely order a computerized tomography (CT) or magnetic resonance imaging (MRI) scan of your sinus to make an accurate diagnosis and determine the site of the leak. […] You may be asked to collect some of the fluid for special testing to confirm it is CSF. […] You may be scheduled for nasal endoscopy after injection of a green dye into the CSF, through a lumbar drain. This further pinpoints the site of the leak and assists in the repair.

• #22 Cerebrospinal Fluid Leak | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cerebrospinal-fluid-leak.html

  Cerebrospinal fluid (CSF) leak occurs 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. […] Diagnosis of a CSF leak generally begins with a physical exam and history. A CSF leak can be difficult to detect, causing misdiagnosis or delayed diagnosis. […] If a cranial CSF leak is suspected, the patients physician may ask them to lean forward so they can observe if this increases the flow of nasal discharge. […] The patients physician also may order tests to examine the condition of the brain and spinal cord. […] A pledget test may be used to determine if a cranial CSF leak is occurring by placing small cotton pads (pledgets) in the nose. […] A CT scan, MRI, myelogram or a cisternogram can assist the physician in determining the location of the leak in either the cranial or spinal area.

• #23

  https://umiamihealth.org/en/treatments-and-services/ear,-nose,-and-throat-(ent)/sinus-and-allergy/cerebrospinal-fluid-leaks-(cfs)

  Cerebrospinal fluid (CSF) is a liquid contained within the lining around the brain, called the dura. When there is a hole in the dura and bone, separating the brain from the sinuses, CSF can leak into the sinuses. This can cause clear, water-like fluid drainage from the nose or into the back of the throat. If the CSF drains out of the nose, it is usually from one side. If it drains into the throat, it has been described as salty tasting. […] If a CSF leak is suspected, your ENT specialist will likely order a computerized tomography (CT) or magnetic resonance imaging (MRI) scan of your sinus to make an accurate diagnosis and determine the site of the leak. […] You may be asked to collect some of the fluid for special testing to confirm it is CSF. […] You may be scheduled for nasal endoscopy after injection of a green dye into the CSF, through a lumbar drain. This further pinpoints the site of the leak and assists in the repair.

• #24 Diagnosis of Spinal CSF leak – Diagnosis – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/about-spinal-csf-leaks/diagnosis-of-spinal-csf-leak/

  Recognizing and diagnosing spinal CSF leak can be challenging, largely due to low familiarity on the part of health care professionals. […] The most important clues to the diagnosis of intracranial hypotension lie in the patient history. […] The hallmark symptom is head pain that is worse when upright and improved with horizontal positioning. […] Lumbar punctures, epidural injections and spinal surgery occurring prior to onset of symptoms may be responsible for a spinal CSF leak. […] Spinal CSF leaks that develop spontaneously or with minimal precipitant may be related to an underlying weakness of the spinal dura. […] Spontaneous leaks are also associated with calcified discs or bone spurs that may or may not be known prior to the onset of symptoms. […] Misdiagnosis and delayed diagnosis of spinal CSF leak remain common, largely due to low familiarity by health care professionals, as we see with all uncommonly recognized disorders.

• #25 Spinal CSF Leak Patient Guide | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/neurosciences/cerebrospinal-fluid-leak-program/cerebrospinal-fluid-leak-patient-guide

  The most common cause of intracranial hypotension is a cerebrospinal fluid (CSF) leak. […] A CSF leak can occur after some medical procedures such as a lumbar puncture (spinal tap), epidural injections or spinal surgery. […] Fortunately, there have been many advances in the diagnosis and treatment of this rare condition over the past decade. Some examples of the imaging tools used to diagnose CSF leaks include: […] MRI (magnetic resonance imaging): Scan of the brain with and without contrast is important to look for common specific findings of CSF leak. In about 80 percent of cases, the MRI of brain will show a series of findings common in CSF leaks including: […] Dynamic Myelogram: This is a procedure in which a physician injects contrast dye directly into the spinal canal and watches for leakage under X-ray and CT.

• #26 Cerebrospinal Fluid Leak – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538157/

  Therefore, the presence of signs and symptoms of a CSF leak indicates the need for further evaluation and management. […] Evaluating a suspected leak should include testing rhinorrhea or otorrhea for beta-2 transferrin, a compound found only in CSF and perilymph, making it a highly specific and sensitive test. […] If beta-transferrin is positive during an acute leak or if there is a high index of suspicion, imaging is indicated to localize the source. […] A careful diagnostic evaluation of patients clinically suspected to have CSF leak is crucial, with the awareness of CSF components and imaging abnormalities. […] Treatment of a CSF leak depends on the underlying cause, size, and location of the tear. […] If it is a small leak, it may resolve on its own, while larger leaks may require surgical intervention.

• #27 Cerebrospinal Fluid (CSF) Leak: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16854-cerebrospinal-fluid-csf-leak

  A cerebrospinal fluid leak (CSF) is when you’re leaking the fluid that surrounds your brain and spinal cord. […] CSF leaks can often cause severe symptoms, but this condition is very treatable, and up to 98% of people with it will recover. […] Experts don’t know exactly how common CSF leaks are because they’re difficult to diagnose. […] A healthcare provider can diagnose a CSF leak using a physical examination, along with gathering information about your symptoms, and asking questions about your medical history and circumstances. […] The combination of tests and methods they use depends on the suspected location of the leak, and whether or not you have any injuries (past or present) that could play a role. […] There are several possible tests for CSF leaks. Most of them are imaging tests, which offer healthcare providers a way to look inside your head and back to locate possible leaks or damage that could contribute to them.

• #28 Cerebrospinal Fluid (CSF) Leak | Choose the Right Test

  https://arupconsult.com/content/csf-leak-beta-2-transferrin

  Cerebrospinal fluid (CSF) leaks (also known as CSF fistulas) result from dura mater defects or tears that enable CSF to escape containment. CSF leaks may be spinal or cranial. Tears in the dura mater primarily arise from craniofacial trauma or after procedures such as endoscopic sinus surgery and lumbar puncture. CSF leaks can also occur spontaneously, or in relation to infection, hydrocephalus, congenital malformations, or neoplasms. The most severe consequences of a CSF leak are brain abscess or bacterial meningitis due to the passage of bacteria into craniospinal spaces. Early diagnosis and intervention, particularly in the case of cranial CSF leaks, are critical to prevent these outcomes. […] Diagnosis of cranial leaks can be challenging in outpatient and postsurgical contexts, in part because such leaks can be difficult to distinguish from chronic rhinitis. Beta-2 transferrin testing is the preferred laboratory approach to assess patients for cranial CSF leaks because it is highly specific and sensitive for CSF secretions.

• #29 Cerebrospinal Fluid Leak – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538157/

  Therefore, the presence of signs and symptoms of a CSF leak indicates the need for further evaluation and management. […] Evaluating a suspected leak should include testing rhinorrhea or otorrhea for beta-2 transferrin, a compound found only in CSF and perilymph, making it a highly specific and sensitive test. […] If beta-transferrin is positive during an acute leak or if there is a high index of suspicion, imaging is indicated to localize the source. […] A careful diagnostic evaluation of patients clinically suspected to have CSF leak is crucial, with the awareness of CSF components and imaging abnormalities. […] Treatment of a CSF leak depends on the underlying cause, size, and location of the tear. […] If it is a small leak, it may resolve on its own, while larger leaks may require surgical intervention.

• #30 Cerebrospinal fluid rhinorrhoea: diagnosis and management

  http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1698-69462007000500014

  CSF leak most commonly occurs following trauma (80-90 % of cases) and the majority of cases presenting within the first three months. In the presence of a skull base fracture on CT and a clinical CSF leak, there is no need for a further confirmatory test. In cases where a confirmatory test is needed, the beta-2 transferrin assay is the test of choice because of its high sensitivity and specificity. […] Diagnosis through nasal inspection and performance of laboratory tests of the fluid can be conducted. In some cases, there is contamination of the material with blood or other secretions, so the test with beta-2 transferrine becomes mandatory. Beta-2 transferrin is a carbohydrate-free (desialated) isoform of transferrin, which is almost exclusively found in the CSF and blood or nasal secretion does not disturb the test. Beta-2 transferrin was reported to have a sensitivity of near 100% and a specificity of about 95% in a large retrospective study.

• #31 Cerebrospinal Fluid (CSF) Leak | Choose the Right Test

  https://arupconsult.com/content/csf-leak-beta-2-transferrin

  Cerebrospinal fluid (CSF) leaks (also known as CSF fistulas) result from dura mater defects or tears that enable CSF to escape containment. CSF leaks may be spinal or cranial. Tears in the dura mater primarily arise from craniofacial trauma or after procedures such as endoscopic sinus surgery and lumbar puncture. CSF leaks can also occur spontaneously, or in relation to infection, hydrocephalus, congenital malformations, or neoplasms. The most severe consequences of a CSF leak are brain abscess or bacterial meningitis due to the passage of bacteria into craniospinal spaces. Early diagnosis and intervention, particularly in the case of cranial CSF leaks, are critical to prevent these outcomes. […] Diagnosis of cranial leaks can be challenging in outpatient and postsurgical contexts, in part because such leaks can be difficult to distinguish from chronic rhinitis. Beta-2 transferrin testing is the preferred laboratory approach to assess patients for cranial CSF leaks because it is highly specific and sensitive for CSF secretions.

• #32 CSF leak (Cerebrospinal Fluid Leak) | Diagnosis & Treatment | Freedmans Health

  https://freedmanshealth.org/diseases-conditions/diagnosis-treatment/csf-leak/

  A healthcare provider can diagnose a CSF leak using a physical examination, along with gathering information about your symptoms, and asking questions about your medical history and circumstances. Its also very likely that theyll use certain kinds of lab tests and diagnostic imaging scans to confirm or rule out a CSF leak. […] The combination of tests and methods they use depends on the suspected location of the leak, and whether or not you have any injuries (past or present) that could play a role. […] There are several possible tests for CSF leaks. Most of them are imaging tests, which offer healthcare providers a way to look inside your head and back to locate possible leaks or damage that could contribute to them. […] If you have CSF leak symptoms specific to your nose or face (especially a runny nose), your provider will likely want to test that fluid. The most likely lab test to help is a beta-2 transferrin test. This test looks for tau, a protein found in CSF but not in nasal mucus. Another possible test is a glucose test, as CSF has about the same amount of glucose as your blood, while nasal mucus has little-to-no glucose. […] The most likely imaging and diagnostic tests include: Computerized tomography (CT) scans, Magnetic resonance imaging (MRI) scans, Digital subtraction angiography, Myelography, Cisternography, Lumbar puncture (spinal tap). […] This is usually not a first-line test for CSF leak.

• #33 The Management of Cranial and Spinal CSF Leaks – Barrow Neurological Institute

  https://www.barrowneuro.org/for-physicians-researchers/education/grand-rounds-publications-media/barrow-quarterly/volume-17-no-4-2001/the-management-of-cranial-and-spinal-csf-leaks/

  The management of patients with a CSF fistula requires confirmation of the diagnosis and localization of the responsible defect. […] If sufficient blood-free drainage can be collected, measurement of the patient’s glucose level of the fluid can be used to confirm the diagnosis of a CSF leak. […] All patients with head injury and basal skull fractures should undergo evaluation for a possible CSF leak. […] In patients with spontaneous CSF leaks, the diagnosis may be more difficult to confirm because the leak may be small and intermittent drainage is common. […] Accurate localization of the site of the CSF fistula is essential whenever surgical intervention is being considered. […] When the diagnosis of a CSF fistula has been confirmed but its location remains elusive, endoscopic techniques may be helpful.

• #34 Cerebrospinal Fluid Leak | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cerebrospinal-fluid-leak.html

  Cerebrospinal fluid (CSF) leak occurs 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. […] Diagnosis of a CSF leak generally begins with a physical exam and history. A CSF leak can be difficult to detect, causing misdiagnosis or delayed diagnosis. […] If a cranial CSF leak is suspected, the patients physician may ask them to lean forward so they can observe if this increases the flow of nasal discharge. […] The patients physician also may order tests to examine the condition of the brain and spinal cord. […] A pledget test may be used to determine if a cranial CSF leak is occurring by placing small cotton pads (pledgets) in the nose. […] A CT scan, MRI, myelogram or a cisternogram can assist the physician in determining the location of the leak in either the cranial or spinal area.

• #35 Cerebrospinal Fluid Leak: When Are Symptoms Serious?

  https://www.verywellhealth.com/cerebrospinal-fluid-leak-7507534

  If you show symptoms of CSF leak, the following diagnostic tests may be suggested: Nasal fluid analysis to check for a type of protein found in CSF fluid, Computed tomography (CT) scan to examine bones and the planes protecting the brain, Magnetic resonance imaging (MRI) scan to help locate the leak and determine severity, Spinal tap or lumbar puncture that adds a specific fluid to CSF to help determine leak location, CT cisternogram utilizing an injectable contrast medium and CT scan to help find a CSF leak associated with the nasal cavity or mastoid bone, Pledget (cotton ball) test with an injectable radioactive tracer and cotton balls inserted into nose to collect fluid leak and help confirm if CSF is leaking into the nose or mastoid bone at the base of the skull, Myelogram scan with an injectable contrasting medium and MRI or CT scan to look for tears or ruptures in the dura.

• #36 Cerebrospinal Fluid Leak – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538157/

  Therefore, the presence of signs and symptoms of a CSF leak indicates the need for further evaluation and management. […] Evaluating a suspected leak should include testing rhinorrhea or otorrhea for beta-2 transferrin, a compound found only in CSF and perilymph, making it a highly specific and sensitive test. […] If beta-transferrin is positive during an acute leak or if there is a high index of suspicion, imaging is indicated to localize the source. […] A careful diagnostic evaluation of patients clinically suspected to have CSF leak is crucial, with the awareness of CSF components and imaging abnormalities. […] Treatment of a CSF leak depends on the underlying cause, size, and location of the tear. […] If it is a small leak, it may resolve on its own, while larger leaks may require surgical intervention.

• #37 Diagnosis of Spinal CSF leak – Diagnosis – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/about-spinal-csf-leaks/diagnosis-of-spinal-csf-leak/

  Diagnostic testing includes lumbar puncture (not required), cranial (brain) imaging, spinal imaging, and occasionally a nuclear medicine study called a radioisotope cisternogram. […] Cranial imaging includes both MRI and CT. An MRI of the brain should be done in ALL cases where a spinal CSF leak is suspected. […] Spinal imaging is performed to localize leaks. […] An LP may be done to measure the opening pressure and to collect CSF for analysis, but this is not required to make the diagnosis. […] There are five findings typically seen on imaging that can be remembered by the mnemonic SEEPS when considering the diagnosis of spinal CSF leak. […] The following are some of the established criteria for diagnosis of spinal CSF leak. […] Orthostatic headache caused by low cerebrospinal fluid (CSF) pressure of spontaneous origin. […] In patients with typical orthostatic headache and no apparent cause, and after exclusion of postural orthostatic tachycardia syndrome (POTS), it is reasonable in clinical practice to provide autologous lumbar epidural blood patch (EBP).

• #38 Cerebrospinal Fluid Leak Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/338989-overview

  First-line imaging techniques of the spine include CT myelography (CTM) and MRI, which may be followed by dynamic myelography, digital subtraction myelography, and dynamic CTM to identify the site of a high-flow leak. […] A suggested algorithm for the diagnosis of a CSF fistula follows: Fluid leaking from the nose or external auditory canal must first be positively identified as CSF. Drops of fluid from a CSF leak placed on absorbent filter paper may result in the double-ring sign: a central circle of blood and an outer clear ring of CSF. […] Confirm or exclude the presence of CSF in leaking fluid by means of an immunoelectrophoretic study of the fluid for beta-2 transferrin (B2Tr) or, where available, beta-trace protein. […] Perform high-resolution, thin-section axial and coronal cranial and facial computed tomography (CT) scanning.

• #39 Diagnosis of Spinal CSF leak – Diagnosis – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/about-spinal-csf-leaks/diagnosis-of-spinal-csf-leak/

  Diagnostic testing includes lumbar puncture (not required), cranial (brain) imaging, spinal imaging, and occasionally a nuclear medicine study called a radioisotope cisternogram. […] Cranial imaging includes both MRI and CT. An MRI of the brain should be done in ALL cases where a spinal CSF leak is suspected. […] Spinal imaging is performed to localize leaks. […] An LP may be done to measure the opening pressure and to collect CSF for analysis, but this is not required to make the diagnosis. […] There are five findings typically seen on imaging that can be remembered by the mnemonic SEEPS when considering the diagnosis of spinal CSF leak. […] The following are some of the established criteria for diagnosis of spinal CSF leak. […] Orthostatic headache caused by low cerebrospinal fluid (CSF) pressure of spontaneous origin. […] In patients with typical orthostatic headache and no apparent cause, and after exclusion of postural orthostatic tachycardia syndrome (POTS), it is reasonable in clinical practice to provide autologous lumbar epidural blood patch (EBP).

• #40 Diagnosis of a CSF Leak | CSF Leak Association

  https://csfleak.uk/resource/diagnosis-of-csf-leak

  Beta-2-Transferrin testing can be a successful, non-invasive test for confirming the presence of cranial CSF leaks. […] Where a traumatic cranial CSF leak is suspected, nasal endoscopy is often performed. […] Intracranial pressure (ICP) monitoring uses a device placed inside the head to measure the pressure inside the skull. […] A lumbar puncture (sometimes known as a spinal tap) is a diagnostic procedure used to test cerebrospinal fluid for conditions such as meningitis and subarachnoid haemorrhage, as well as checking intracranial pressure. […] Where a suspected spontaneous spinal CSF leak is concerned, it is important that medical professionals carefully weigh up the benefits of a lumbar puncture over the potential risk of creating a new leak or worsening existing symptoms. […] Multiple imaging studies have been used to localise cranial defects which can cause cranial leaks, but the most common technique is high-resolution Computed Tomographic (HRCT) scanning.

• #41 Diagnosing Spinal CSF Leaks & SIH: Symptoms, Tests & Specialist Evaluation — SPINAL CSF LEAK CANADA

  https://www.spinalcsfleakcanada.ca/spinal-csf-leak-diagnosis

  A Lumbar puncture is not a helpful diagnostic tool and is not required to make a diagnosis. The risks of the procedure outweigh its benefits. […] A CSF leak is often misdiagnosed as one of the following conditions: Chronic migraine, Chronic tension type headache, Chiari malformation 1, Postural orthostatic tachycardia syndrome (POTS), Dementia (in some very rare cases), Cervicogenic headache, New daily persistent headache (NDPH). […] It is a myth and a misconception that a negative brain MRI excludes the possibility of SIH. […] About 15-20% of patients with spinal CSF leak(s) have normal MRI brain imaging. […] A negative MRI does not rule out a spinal CSF leak but a positive MRI does rule in a spinal CSF leak. […] Opening pressure (OP) is not an effective predictor for diagnosing spinal CSF leak s and if used in isolation would result in misdiagnosis.

• #42

  https://medschool.cuanschutz.edu/radiology/sections/neuroradiology/csf-leak-program/about

  The University of Colorado CSF Leak Program specializes in the diagnosis and treatment of spontaneous intracranial hypotension (SIH). […] Once considered to be a diagnosis made only in individuals with an abnormal brain MRI, we are now understanding that patients may or may not present with an abnormal brain MRI but still have a spinal fluid leak. […] A type of leak called a CSF-venous fistula (CVF) was only discovered in 2014, and requires specialized testing called dynamic myelography in order to diagnose. […] Our clinic director, Dr. Andrew Callen, is a neuroradiologist who specializes in diagnosing and treating CSF leaks.

• #43 Diagnosing Spinal CSF Leaks & SIH: Symptoms, Tests & Specialist Evaluation — SPINAL CSF LEAK CANADA

  https://www.spinalcsfleakcanada.ca/spinal-csf-leak-diagnosis

  Different types of imaging include: […] Brain MRI (with and without contrast) should be done in all cases where a spinal CSF leak is suspected. […] The brain (Bern) SIH-Score (bSIH-Score) is a quantitive scoring system of cranial MRI used to indicate the likelihood of identifying a CSF leak during more specialized spinal imaging. […] Some of the most common abnormalities that can be found suggesting possible CSF leakage through a full spinal MRI are: fluid collections, collapse of the dural sac and irregular root sleeves. […] If invasive testing is required however, CT myelography is the study of choice for locating a leak once spinal a CSF leak is suspected. […] Sustained improvement of symptoms after epidural blood patching is a good indication of a spinal CSF leak. […] The results of a neurological examination are usually normal, but may show some signs related to the neurological symptoms caused by a CSF leak.

• #44 Diagnosing Spinal CSF Leaks & SIH: Symptoms, Tests & Specialist Evaluation — SPINAL CSF LEAK CANADA

  https://www.spinalcsfleakcanada.ca/spinal-csf-leak-diagnosis

  Different types of imaging include: […] Brain MRI (with and without contrast) should be done in all cases where a spinal CSF leak is suspected. […] The brain (Bern) SIH-Score (bSIH-Score) is a quantitive scoring system of cranial MRI used to indicate the likelihood of identifying a CSF leak during more specialized spinal imaging. […] Some of the most common abnormalities that can be found suggesting possible CSF leakage through a full spinal MRI are: fluid collections, collapse of the dural sac and irregular root sleeves. […] If invasive testing is required however, CT myelography is the study of choice for locating a leak once spinal a CSF leak is suspected. […] Sustained improvement of symptoms after epidural blood patching is a good indication of a spinal CSF leak. […] The results of a neurological examination are usually normal, but may show some signs related to the neurological symptoms caused by a CSF leak.

• #45 CSF leak (Cerebrospinal fluid leak) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/csf-leak/diagnosis-treatment/drc-20522247

  Your healthcare professional will likely start by asking about your medical history and conducting a physical exam. […] Tests to diagnose a spinal CSF leak may include: […] MRI with gadolinium. An MRI scan uses a magnetic field and radio waves to produce detailed images of the brain, spinal cord and other areas of the body. Using MRI with gadolinium makes it easier to see any changes in the 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, several images of the area are taken over a 24-hour period. These images watch for changes in the flow of CSF that may indicate a leak. […] Myelography. This imaging test uses a contrast dye and X-rays or computed tomography (CT) to take detailed pictures of the spine. It can find the exact location of a CSF leak and helps to determine the most appropriate treatment plan.

• #46 Diagnosis of a CSF Leak | CSF Leak Association

  https://csfleak.uk/resource/diagnosis-of-csf-leak

  HRCT technology can be used with most surgical image guidance systems. […] Intrathecal agents can be used both to confirm the presence of, and to attempt to localise, CSF leaks. […] Studies have shown that approximately 80% of CSF leaks can be confirmed through this technology. […] Magnetic Resonance Imaging (MRI) is generally thought to be less effective than CT Myelography or MR Myelography at detecting the specific site of CSF leak, unless it stems from a sizable tear. […] MR Myelography comprises a special MRI technique in which a sequence with heavy T2-weighting is used to provide high contrast between the dark spinal cord and its nerves and the surrounding bright cerebrospinal fluid, mimicking the results of Computed Tomographic (CT) Myelography. […] Digital subtraction myelography has been shown to be a valuable diagnostic tool for the localisation of rapid spinal CSF leaks and is increasingly considered in patients who are clinically suspected to have a dural tear that is accompanied by a longitudinally extensive extradural fluid collection on spinal MRI.

• #47 Diagnosis of a CSF Leak | CSF Leak Association

  https://csfleak.uk/resource/diagnosis-of-csf-leak

  HRCT technology can be used with most surgical image guidance systems. […] Intrathecal agents can be used both to confirm the presence of, and to attempt to localise, CSF leaks. […] Studies have shown that approximately 80% of CSF leaks can be confirmed through this technology. […] Magnetic Resonance Imaging (MRI) is generally thought to be less effective than CT Myelography or MR Myelography at detecting the specific site of CSF leak, unless it stems from a sizable tear. […] MR Myelography comprises a special MRI technique in which a sequence with heavy T2-weighting is used to provide high contrast between the dark spinal cord and its nerves and the surrounding bright cerebrospinal fluid, mimicking the results of Computed Tomographic (CT) Myelography. […] Digital subtraction myelography has been shown to be a valuable diagnostic tool for the localisation of rapid spinal CSF leaks and is increasingly considered in patients who are clinically suspected to have a dural tear that is accompanied by a longitudinally extensive extradural fluid collection on spinal MRI.

• #48 Cerebrospinal fluid leak – Wikipedia

  https://en.wikipedia.org/wiki/Cerebrospinal_fluid_leak

  A cerebrospinal fluid leak (CSF leak or CSFL) is a medical condition where the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord leaks out of one or more holes or tears in the dura mater. A CSF leak is classed as either spontaneous (primary), having no known cause (sCSF leak), or nonspontaneous (secondary) where it is attributed to an underlying condition. […] A cerebrospinal fluid leak can be either cranial or spinal, and these are two different disorders. […] A CT myelography scan can identify the site of a cerebrospinal fluid leakage. […] The primary place of first complaint to a physician is a hospital emergency room. Up to 94% of those with sCSFLS are initially misdiagnosed. […] Diagnosis of a cerebrospinal fluid leak is performed through a combination of non-invasive measurement of intracranial pressure methods of the CSF pressure, and a computed tomography myelogram (CTM) scan of the spinal column for fluid leaks. […] For patients with recalcitrant spontaneous intracranial hypotension and no leak found on conventional spinal imaging, digital subtraction myelography, CT myelography and dynamic myelography (a modified conventional myelography technique) should be considered to rule out a CSF-venous fistula.

• #49 Cerebrospinal fluid leak – Wikipedia

  https://en.wikipedia.org/wiki/Cerebrospinal_fluid_leak

  A cerebrospinal fluid leak (CSF leak or CSFL) is a medical condition where the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord leaks out of one or more holes or tears in the dura mater. A CSF leak is classed as either spontaneous (primary), having no known cause (sCSF leak), or nonspontaneous (secondary) where it is attributed to an underlying condition. […] A cerebrospinal fluid leak can be either cranial or spinal, and these are two different disorders. […] A CT myelography scan can identify the site of a cerebrospinal fluid leakage. […] The primary place of first complaint to a physician is a hospital emergency room. Up to 94% of those with sCSFLS are initially misdiagnosed. […] Diagnosis of a cerebrospinal fluid leak is performed through a combination of non-invasive measurement of intracranial pressure methods of the CSF pressure, and a computed tomography myelogram (CTM) scan of the spinal column for fluid leaks. […] For patients with recalcitrant spontaneous intracranial hypotension and no leak found on conventional spinal imaging, digital subtraction myelography, CT myelography and dynamic myelography (a modified conventional myelography technique) should be considered to rule out a CSF-venous fistula.

• #50 Spinal CSF Leak Patient Guide | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/neurosciences/cerebrospinal-fluid-leak-program/cerebrospinal-fluid-leak-patient-guide

  The most common cause of intracranial hypotension is a cerebrospinal fluid (CSF) leak. […] A CSF leak can occur after some medical procedures such as a lumbar puncture (spinal tap), epidural injections or spinal surgery. […] Fortunately, there have been many advances in the diagnosis and treatment of this rare condition over the past decade. Some examples of the imaging tools used to diagnose CSF leaks include: […] MRI (magnetic resonance imaging): Scan of the brain with and without contrast is important to look for common specific findings of CSF leak. In about 80 percent of cases, the MRI of brain will show a series of findings common in CSF leaks including: […] Dynamic Myelogram: This is a procedure in which a physician injects contrast dye directly into the spinal canal and watches for leakage under X-ray and CT.

• #51 CSF leak (Cerebrospinal fluid leak) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/csf-leak/diagnosis-treatment/drc-20522247

  Spinal tap. This test also is called lumbar puncture. It involves placing a needle in the spinal column to measure the pressure of CSF inside the spinal column. It is usually performed as part of another test for CSF leak. For example, a spinal tap is required at the start of myelography or cisternography. […] Tests to diagnose a cranial CSF leak may include: […] MRI with gadolinium. An MRI scan may be used to help detect a CSF leak inside the brain. Using it with gadolinium, a contrast agent, helps to highlight irregularities in the brain and locate the source of a CSF leak. […] CT cisternography. This test is considered the gold standard for diagnosing and locating cranial CSF leaks. It uses a CT scan and a contrast dye to locate CSF leaks anywhere in the skull base. This test can show exactly where a CSF leak is, and help to determine the most appropriate treatment plan.

• #52 Diagnosing a CSF Leak | Neurological Surgery

  https://neurosurgery.weillcornell.org/condition/csf-leaks/diagnosing-csf-leak

  An MRI scan of the skull base or the auditory canal with contrast to identify a cranial CSF leak; this is especially useful in patients whose symptoms are intermittent. […] CT or MR cisternogram, during which contrast is injected into the spinal canal by image-guided lumbar puncture; imaging by CT or MR is obtained to look for the site of the CSF leak […] Beta-trace protein or beta-2 transferrin test, which starts with an attempt to collect some of the leaking fluid for testing. Fluid that contains beta-trace protein or beta-2 transferrin both of which are found in cerebrospinal fluid is presumed to be from a CSF leak.

• #53 CSF leak (Cerebrospinal fluid leak) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/csf-leak/diagnosis-treatment/drc-20522247

  Your healthcare professional will likely start by asking about your medical history and conducting a physical exam. […] Tests to diagnose a spinal CSF leak may include: […] MRI with gadolinium. An MRI scan uses a magnetic field and radio waves to produce detailed images of the brain, spinal cord and other areas of the body. Using MRI with gadolinium makes it easier to see any changes in the 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, several images of the area are taken over a 24-hour period. These images watch for changes in the flow of CSF that may indicate a leak. […] Myelography. This imaging test uses a contrast dye and X-rays or computed tomography (CT) to take detailed pictures of the spine. It can find the exact location of a CSF leak and helps to determine the most appropriate treatment plan.

• #54 Cerebrospinal Fluid (CSF) Leak | Choose the Right Test

  https://arupconsult.com/content/csf-leak-beta-2-transferrin

  Although radionucleotide cisternography may be helpful to assess patients with possible intermittent or low-volume CSF leaks, it is not recommended as a routine approach to diagnose or confirm cranial CSF leaks because of its higher cost, lower accuracy, and invasive nature compared with beta-2 transferrin testing.

• #55 68Ga-DOTA PET for Diagnosis of Spinal Cerebrospinal Fluid Leaks | Journal of Nuclear Medicine

  https://jnm.snmjournals.org/content/64/3/430

  Spontaneous intracranial hypotension due to spinal cerebrospinal fluid (CSF) leakage causes substantial disease burden. […] We propose PET of the CSF space with 68Ga-DOTA as a state-of-the-art approach to radionuclide cisternography (RC) and validate its diagnostic value. […] A spinal CSF leak was verified by the neuroradiologic reference method in 18 of 39 patients. […] As the only direct and indirect diagnostic signs, extrathecal tracer accumulation at the cervicothoracic junction (67% sensitivity and 90% specificity) and lack of activity over the cerebral convexities (5 h; 94% sensitivity and 67% specificity) revealed a high diagnostic value for spinal CSF leaks. […] We propose CSF PET with 68Ga-DOTA as a novel, fast, and convenient approach to RC for verification but not localization of spinal CSF leaks with high sensitivity and specificity.

• #56 68Ga-DOTA PET for Diagnosis of Spinal Cerebrospinal Fluid Leaks | Journal of Nuclear Medicine

  https://jnm.snmjournals.org/content/64/3/430

  CSF PET may fulfill an important gatekeeper function for stratifying patients toward escalation (ruling in) or deescalation (ruling out) of diagnostic and therapeutic measures. […] The present retrospective study included 39 consecutive adults with suspected intracranial hypotension and who underwent 68Ga-DOTA CSF PET. Extrathecal tracer accumulation at the cervicothoracic junction (67% sensitivity and 90% specificity) and lack of activity over the cerebral convexities (5 h; 94% sensitivity and 67% specificity) revealed a high diagnostic value for spinal CSF leaks. […] CSF PET with 68Ga-DOTA may serve as a gatekeeper for stratifying patients toward escalation or deescalation of further diagnostic and therapeutic measures and, thus, reducing the burden to patients.

• #57 CSF leak (Cerebrospinal fluid leak) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/csf-leak/diagnosis-treatment/drc-20522247

  Spinal tap. This test also is called lumbar puncture. It involves placing a needle in the spinal column to measure the pressure of CSF inside the spinal column. It is usually performed as part of another test for CSF leak. For example, a spinal tap is required at the start of myelography or cisternography. […] Tests to diagnose a cranial CSF leak may include: […] MRI with gadolinium. An MRI scan may be used to help detect a CSF leak inside the brain. Using it with gadolinium, a contrast agent, helps to highlight irregularities in the brain and locate the source of a CSF leak. […] CT cisternography. This test is considered the gold standard for diagnosing and locating cranial CSF leaks. It uses a CT scan and a contrast dye to locate CSF leaks anywhere in the skull base. This test can show exactly where a CSF leak is, and help to determine the most appropriate treatment plan.

• #58 Diagnosis of a CSF Leak | CSF Leak Association

  https://csfleak.uk/resource/diagnosis-of-csf-leak

  Beta-2-Transferrin testing can be a successful, non-invasive test for confirming the presence of cranial CSF leaks. […] Where a traumatic cranial CSF leak is suspected, nasal endoscopy is often performed. […] Intracranial pressure (ICP) monitoring uses a device placed inside the head to measure the pressure inside the skull. […] A lumbar puncture (sometimes known as a spinal tap) is a diagnostic procedure used to test cerebrospinal fluid for conditions such as meningitis and subarachnoid haemorrhage, as well as checking intracranial pressure. […] Where a suspected spontaneous spinal CSF leak is concerned, it is important that medical professionals carefully weigh up the benefits of a lumbar puncture over the potential risk of creating a new leak or worsening existing symptoms. […] Multiple imaging studies have been used to localise cranial defects which can cause cranial leaks, but the most common technique is high-resolution Computed Tomographic (HRCT) scanning.

• #59 Diagnosing Spinal CSF Leaks & SIH: Symptoms, Tests & Specialist Evaluation — SPINAL CSF LEAK CANADA

  https://www.spinalcsfleakcanada.ca/spinal-csf-leak-diagnosis

  A Lumbar puncture is not a helpful diagnostic tool and is not required to make a diagnosis. The risks of the procedure outweigh its benefits. […] A CSF leak is often misdiagnosed as one of the following conditions: Chronic migraine, Chronic tension type headache, Chiari malformation 1, Postural orthostatic tachycardia syndrome (POTS), Dementia (in some very rare cases), Cervicogenic headache, New daily persistent headache (NDPH). […] It is a myth and a misconception that a negative brain MRI excludes the possibility of SIH. […] About 15-20% of patients with spinal CSF leak(s) have normal MRI brain imaging. […] A negative MRI does not rule out a spinal CSF leak but a positive MRI does rule in a spinal CSF leak. […] Opening pressure (OP) is not an effective predictor for diagnosing spinal CSF leak s and if used in isolation would result in misdiagnosis.

• #60 Diagnosing Spinal CSF Leaks & SIH: Symptoms, Tests & Specialist Evaluation — SPINAL CSF LEAK CANADA

  https://www.spinalcsfleakcanada.ca/spinal-csf-leak-diagnosis

  A Lumbar puncture is not a helpful diagnostic tool and is not required to make a diagnosis. The risks of the procedure outweigh its benefits. […] A CSF leak is often misdiagnosed as one of the following conditions: Chronic migraine, Chronic tension type headache, Chiari malformation 1, Postural orthostatic tachycardia syndrome (POTS), Dementia (in some very rare cases), Cervicogenic headache, New daily persistent headache (NDPH). […] It is a myth and a misconception that a negative brain MRI excludes the possibility of SIH. […] About 15-20% of patients with spinal CSF leak(s) have normal MRI brain imaging. […] A negative MRI does not rule out a spinal CSF leak but a positive MRI does rule in a spinal CSF leak. […] Opening pressure (OP) is not an effective predictor for diagnosing spinal CSF leak s and if used in isolation would result in misdiagnosis.

• #61 Diagnosing Spinal CSF Leaks & SIH: Symptoms, Tests & Specialist Evaluation — SPINAL CSF LEAK CANADA

  https://www.spinalcsfleakcanada.ca/spinal-csf-leak-diagnosis

  A Lumbar puncture is not a helpful diagnostic tool and is not required to make a diagnosis. The risks of the procedure outweigh its benefits. […] A CSF leak is often misdiagnosed as one of the following conditions: Chronic migraine, Chronic tension type headache, Chiari malformation 1, Postural orthostatic tachycardia syndrome (POTS), Dementia (in some very rare cases), Cervicogenic headache, New daily persistent headache (NDPH). […] It is a myth and a misconception that a negative brain MRI excludes the possibility of SIH. […] About 15-20% of patients with spinal CSF leak(s) have normal MRI brain imaging. […] A negative MRI does not rule out a spinal CSF leak but a positive MRI does rule in a spinal CSF leak. […] Opening pressure (OP) is not an effective predictor for diagnosing spinal CSF leak s and if used in isolation would result in misdiagnosis.

• #62 Cerebrospinal Fluid Leaks ENT Treatment in Utah – ENT Center of Utah

  https://entcenterutah.com/adult-care/sinus/cerebrospinal-fluid-leaks/

  Cerebrospinal Fluid Leaks […] Initially, up to 94% of CSF leaks are misdiagnosed. False diagnoses include sinusitis, meningitis, rhinitis, allergies, migraines, and sinus headache. Typical symptoms include a colorless fluid escaping from the nose (often from only one nostril but can be both sides), headache that feels more painful when upright and improved when lying flat (but other patterns do happen), neck pain or stiffness, stomach irritation and vomiting, a feeling of imbalance, an alteration in hearing, as well as changes in cognition (brain fog) and dizziness. […] The most typical tests used for diagnosing CSF leak are done through an examination from an ear, nose and throat (ENT) specialist. The ENT will most likely use nasal endoscopy, CT and MRI imaging techniques, as well as chemical tests of the liquid that is escaping (beta 2 transferrin test).

• #63 Cerebrospinal fluid leak – Wikipedia

  https://en.wikipedia.org/wiki/Cerebrospinal_fluid_leak

  A cerebrospinal fluid leak (CSF leak or CSFL) is a medical condition where the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord leaks out of one or more holes or tears in the dura mater. A CSF leak is classed as either spontaneous (primary), having no known cause (sCSF leak), or nonspontaneous (secondary) where it is attributed to an underlying condition. […] A cerebrospinal fluid leak can be either cranial or spinal, and these are two different disorders. […] A CT myelography scan can identify the site of a cerebrospinal fluid leakage. […] The primary place of first complaint to a physician is a hospital emergency room. Up to 94% of those with sCSFLS are initially misdiagnosed. […] Diagnosis of a cerebrospinal fluid leak is performed through a combination of non-invasive measurement of intracranial pressure methods of the CSF pressure, and a computed tomography myelogram (CTM) scan of the spinal column for fluid leaks. […] For patients with recalcitrant spontaneous intracranial hypotension and no leak found on conventional spinal imaging, digital subtraction myelography, CT myelography and dynamic myelography (a modified conventional myelography technique) should be considered to rule out a CSF-venous fistula.

• #64 Cerebrospinal Fluid Leaks ENT Treatment in Utah – ENT Center of Utah

  https://entcenterutah.com/adult-care/sinus/cerebrospinal-fluid-leaks/

  Cerebrospinal Fluid Leaks […] Initially, up to 94% of CSF leaks are misdiagnosed. False diagnoses include sinusitis, meningitis, rhinitis, allergies, migraines, and sinus headache. Typical symptoms include a colorless fluid escaping from the nose (often from only one nostril but can be both sides), headache that feels more painful when upright and improved when lying flat (but other patterns do happen), neck pain or stiffness, stomach irritation and vomiting, a feeling of imbalance, an alteration in hearing, as well as changes in cognition (brain fog) and dizziness. […] The most typical tests used for diagnosing CSF leak are done through an examination from an ear, nose and throat (ENT) specialist. The ENT will most likely use nasal endoscopy, CT and MRI imaging techniques, as well as chemical tests of the liquid that is escaping (beta 2 transferrin test).

• #65 Diagnosis of Spinal CSF leak – Diagnosis – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/about-spinal-csf-leaks/diagnosis-of-spinal-csf-leak/

  Diagnostic testing includes lumbar puncture (not required), cranial (brain) imaging, spinal imaging, and occasionally a nuclear medicine study called a radioisotope cisternogram. […] Cranial imaging includes both MRI and CT. An MRI of the brain should be done in ALL cases where a spinal CSF leak is suspected. […] Spinal imaging is performed to localize leaks. […] An LP may be done to measure the opening pressure and to collect CSF for analysis, but this is not required to make the diagnosis. […] There are five findings typically seen on imaging that can be remembered by the mnemonic SEEPS when considering the diagnosis of spinal CSF leak. […] The following are some of the established criteria for diagnosis of spinal CSF leak. […] Orthostatic headache caused by low cerebrospinal fluid (CSF) pressure of spontaneous origin. […] In patients with typical orthostatic headache and no apparent cause, and after exclusion of postural orthostatic tachycardia syndrome (POTS), it is reasonable in clinical practice to provide autologous lumbar epidural blood patch (EBP).

• #66 Diagnostic Criteria for Spontaneous Spinal CSF Leaks and Intracranial Hypotension | American Journal of Neuroradiology

  https://www.ajnr.org/content/29/5/853

  BACKGROUND AND PURPOSE: Comprehensive diagnostic criteria encompassing the varied clinical and radiographic manifestations of spontaneous intracranial hypotension are not available. Therefore, we propose a new set of diagnostic criteria. […] The diagnostic criteria include criterion A, the demonstration of extrathecal CSF on spinal imaging. […] A new diagnostic scheme is presented reflecting the wide spectrum of clinical and radiographic manifestations of spontaneous spinal CSF leaks and intracranial hypotension. […] We report a new set of diagnostic criteria for spontaneous spinal CSF leaks and spontaneous intracranial hypotension encompassing its varied clinical and radiographic manifestations. […] The demonstration of a spinal CSF leak (ie, the presence of extrathecal CSF) is sufficient to diagnose spontaneous intracranial hypotension, regardless of associated symptoms, imaging findings, or results of lumbar puncture and epidural blood patching.

• #67 Cerebrospinal fluid leak – MEpedia

  https://me-pedia.org/wiki/Cerebrospinal_fluid_leak

  A cerebrospinal fluid leak or cerebral spinal fluid leak occurs when a tear or hole happens in the dura mater, the outermost membrane enveloping the brain and spinal cord. […] According to the Spinal CSF Leak Foundation, spinal imaging to aid diagnosis of CSF leaks includes: spinal MRI, MR mylegram, intracathecal gadolinium enhanced spinal MRI, CT myelogram, dynamic CT myelogram, digital subtraction myelogram, and radioisotope cisternogram. […] Diagnostic criteria for spontaneous intracranial hypotension with spinal CSF leaks include: orthostatic headache, no recent history of dural puncture, not attributable to another disorder, and the presence of at least 1 of: low opening pressure (less than or equal to 60 mm of H20), sustained improvement of symptoms after epidural blood patching, demonstration of an active spinal CSF leak, cranial MRI changes of intracranial hypotension (e.g. brain sagging or pachymeningeal enhancement).

• #68 Diagnostic Criteria for Spontaneous Spinal CSF Leaks and Intracranial Hypotension | American Journal of Neuroradiology

  https://www.ajnr.org/content/29/5/853

  BACKGROUND AND PURPOSE: Comprehensive diagnostic criteria encompassing the varied clinical and radiographic manifestations of spontaneous intracranial hypotension are not available. Therefore, we propose a new set of diagnostic criteria. […] The diagnostic criteria include criterion A, the demonstration of extrathecal CSF on spinal imaging. […] A new diagnostic scheme is presented reflecting the wide spectrum of clinical and radiographic manifestations of spontaneous spinal CSF leaks and intracranial hypotension. […] We report a new set of diagnostic criteria for spontaneous spinal CSF leaks and spontaneous intracranial hypotension encompassing its varied clinical and radiographic manifestations. […] The demonstration of a spinal CSF leak (ie, the presence of extrathecal CSF) is sufficient to diagnose spontaneous intracranial hypotension, regardless of associated symptoms, imaging findings, or results of lumbar puncture and epidural blood patching.

• #69 Cerebrospinal Fluid Leak Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/338989-overview

  First-line imaging techniques of the spine include CT myelography (CTM) and MRI, which may be followed by dynamic myelography, digital subtraction myelography, and dynamic CTM to identify the site of a high-flow leak. […] A suggested algorithm for the diagnosis of a CSF fistula follows: Fluid leaking from the nose or external auditory canal must first be positively identified as CSF. Drops of fluid from a CSF leak placed on absorbent filter paper may result in the double-ring sign: a central circle of blood and an outer clear ring of CSF. […] Confirm or exclude the presence of CSF in leaking fluid by means of an immunoelectrophoretic study of the fluid for beta-2 transferrin (B2Tr) or, where available, beta-trace protein. […] Perform high-resolution, thin-section axial and coronal cranial and facial computed tomography (CT) scanning.

• #70 Cerebrospinal fluid rhinorrhoea: diagnosis and management

  http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1698-69462007000500014

  CSF leak most commonly occurs following trauma (80-90 % of cases) and the majority of cases presenting within the first three months. In the presence of a skull base fracture on CT and a clinical CSF leak, there is no need for a further confirmatory test. In cases where a confirmatory test is needed, the beta-2 transferrin assay is the test of choice because of its high sensitivity and specificity. […] Diagnosis through nasal inspection and performance of laboratory tests of the fluid can be conducted. In some cases, there is contamination of the material with blood or other secretions, so the test with beta-2 transferrine becomes mandatory. Beta-2 transferrin is a carbohydrate-free (desialated) isoform of transferrin, which is almost exclusively found in the CSF and blood or nasal secretion does not disturb the test. Beta-2 transferrin was reported to have a sensitivity of near 100% and a specificity of about 95% in a large retrospective study.

• #71 Cerebrospinal Fluid Leak – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538157/

  Therefore, the presence of signs and symptoms of a CSF leak indicates the need for further evaluation and management. […] Evaluating a suspected leak should include testing rhinorrhea or otorrhea for beta-2 transferrin, a compound found only in CSF and perilymph, making it a highly specific and sensitive test. […] If beta-transferrin is positive during an acute leak or if there is a high index of suspicion, imaging is indicated to localize the source. […] A careful diagnostic evaluation of patients clinically suspected to have CSF leak is crucial, with the awareness of CSF components and imaging abnormalities. […] Treatment of a CSF leak depends on the underlying cause, size, and location of the tear. […] If it is a small leak, it may resolve on its own, while larger leaks may require surgical intervention.

• #72 :: KJNT :: Korean Journal of Neurotrauma

  https://kjnt.org/DOIx.php?id=10.13004/kjnt.2017.13.2.63

  Cerebrospinal fluid (CSF) leaks are one of the common complications after traumatic brain injuries (TBI). […] Early diagnosis and proper management is imperative for it is strongly associated with a better long-term prognosis of the patients. […] Diagnostic tools for CSF leaks are still under debate. […] Hereby, we review about the pathophysiology, manifestations as well as the update of the clinical diagnosis and current management of CSF leaks. […] The risk of meningitis from the traumatic CSF leak can present with high morbidity and even mortality depending on the cause and site of CSF leak. […] Thus, early detection of CSF leaks is important as it determines the outcome of the patient. […] The decision of whether to observe or to surgically intervene is most likely to be dependent on the cause, site of leak, and timing of the leak.

• #73 Expert Treatment for Cerebrospinal Fluid Leaks | Skull Base Conditions | Ear, Nose and Throat Services | University Hospitals | Cleveland, OH | University Hospitals

  https://www.uhhospitals.org/services/ear-nose-and-throat-services/conditions-and-treatments/skull-base-conditions/cerebrospinal-fluid-leaks

  Cerebrospinal fluid (CSF) or brain fluid is a clear liquid that surrounds and cushions the brain. […] If you have been diagnosed with or have symptoms of a cerebrospinal fluid leak, it is important to consult with a UH ENT expert for an accurate diagnosis and an effective treatment plan. […] An early and accurate diagnosis of a CSF leak is essential for an optimal treatment outcome and can help prevent infectious complications. […] The ENT experts at University Hospitals have the experience to recognize and diagnose CSF leaks so that the appropriate treatment plan can be developed. […] A sample of the fluid is collected and tested to determine whether or not the fluid is CSF. […] If a CSF leak is strongly suspected or confirmed, imaging tests will be ordered. […] Once a CSF leak is confirmed, the surgical approach to repairing it will depend on whether the fluid is leaking from the ear or the nose.

• #74 Cerebrospinal Fluid Leak – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538157/

  Conservative treatment for a CSF leak typically includes bed rest and increased oral fluids. […] Other treatments for a CSF leak may include nasal packing, endoscopic repair, and surgical repair. […] The epidural blood patch (EBP) procedure is a commonly used treatment for cerebrospinal fluid (CSF) leaks. […] Surgery is recommended when the leak site has been identified, symptoms have been refractory to less invasive treatments, and severe symptoms persist. […] The overall prognosis of CSF leak is very favorable, with one study citing a 90% first-attempt success rate of endoscopic repair of CSF rhinorrhea and another study citing an overall success rate of 98% across traumatic, iatrogenic, and congenital causes.

• #75 Diagnosing Spinal CSF Leaks & SIH: Symptoms, Tests & Specialist Evaluation — SPINAL CSF LEAK CANADA

  https://www.spinalcsfleakcanada.ca/spinal-csf-leak-diagnosis

  Under-diagnosis and/or misdiagnosis of a spinal CSF leak/ Spontaneous intracranial hypotension (SIH) is extremely common, resulting in little or no treatment for some patients suffering from it. Currently, there is not a single diagnostic test that can rule out SIH with a high degree of certainty; therefore, detailed assessment and investigation of symptoms by a specialist is crucial. […] Experts agree that symptoms and history of the patient are extremely important for a successful diagnosis: see SYMPTOMS. […] Some patients with spinal CSF leaks may require a few scans to diagnose a leak, while others require several different types of tests or repeated testing over time to establish the diagnosis. […] There is no diagnostic imaging test that is 100% accurate in determining whether someone is leaking. It is important to note that imaging of patients with spinal CSF leaks may sometimes be normal, and an MRI is not solely adequate in diagnosing a spinal CSF leak. Spinal CSF leaks can exist without any evidence of a leak on imaging. A negative MRI of the brain or spine does not rule out a spinal CSF leak. Even when positive for a CSF leak, current spinal imaging is not always adequate for locating all leaks. Symptoms are usually key in diagnosing a leak, as noted above.

• #76 Diagnosis of Spinal CSF leak – Diagnosis – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/about-spinal-csf-leaks/diagnosis-of-spinal-csf-leak/

  Diagnostic testing includes lumbar puncture (not required), cranial (brain) imaging, spinal imaging, and occasionally a nuclear medicine study called a radioisotope cisternogram. […] Cranial imaging includes both MRI and CT. An MRI of the brain should be done in ALL cases where a spinal CSF leak is suspected. […] Spinal imaging is performed to localize leaks. […] An LP may be done to measure the opening pressure and to collect CSF for analysis, but this is not required to make the diagnosis. […] There are five findings typically seen on imaging that can be remembered by the mnemonic SEEPS when considering the diagnosis of spinal CSF leak. […] The following are some of the established criteria for diagnosis of spinal CSF leak. […] Orthostatic headache caused by low cerebrospinal fluid (CSF) pressure of spontaneous origin. […] In patients with typical orthostatic headache and no apparent cause, and after exclusion of postural orthostatic tachycardia syndrome (POTS), it is reasonable in clinical practice to provide autologous lumbar epidural blood patch (EBP).

• #77 Cerebrospinal Fluid Leak (CSF Leak) FAQ | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/neurosciences/cerebrospinal-fluid-leak-program/cerebrospinal-fluid-leak-faq

  Diagnosis can frequently be based on the postural dependency of the headache. A diagnosis of intracranial hypotension is not usually a first consideration. […] On a MRI brain with contrast, there will typically be thickened and enhancing meninges (ie pachymeningeal enhancement). […] Determining the site of a CSF leak in the spinal canal can be challenging. Some of the methods include: Dynamic myelogram with fluoroscopy and CT scan, Radioisotope cisternography, Digital subtraction myelography. […] In some cases, the site of the leak cannot be identified.

• #78 CSF Leak Diagnosis and Treatment | Henry Ford Health – Detroit, MI

  https://www.henryford.com/services/neurology/headache/what-we-treat/csf-leak

  Henry Ford Health is dedicated to the diagnosis and treatment of spontaneous intracranial hypotension (SIH), a condition caused by cerebrospinal fluid (CSF) leakage from the spine. […] It was once believed that SIH could only be diagnosed through an abnormal brain MRI, but we now know that some patients with normal brain MRIs may still have a CSF leak. […] Furthermore, a specific type of leak, known as a CSF-venous fistula (CVF), was identified only in 2014 and requires specialized testing, such as dynamic myelography, for accurate diagnosis. […] Our dedicated CSF team includes a fellowship-trained neuroradiologist with expertise in CSF leaks, along with radiologists, neurologists and neurosurgeons to offer the latest diagnostic techniques and treatment options for this complex condition. […] After your initial assessment, your case will be discussed at our weekly multidisciplinary conference, where a team of neurologists, neuroradiologists and neurosurgeons will collaborate to determine a consensus on your diagnosis and treatment plan.

• #79 Spinal CSF Leak Foundation – Home – Spinal CSF Leak Foundation

  https://spinalcsfleak.org/

  Our mission at the Spinal CSF Leak Foundation is to reduce the suffering of any person affected by intracranial hypotension or spinal cerebrospinal fluid leak. With the right diagnosis and access to the right testing and treatments, more patients will have an improved quality of life. […] Spinal cerebrospinal fluid (CSF) leak is an important and under-diagnosed cause of new onset headache that is treatable and curable in many cases. […] This is a diagnosis that tends to be missed when it occurs out of the blue, while cases that arise after medical procedures like lumbar punctures and spinal surgery are usually recognized more quickly. However, there is hope: Like a plumbing leak, a spinal CSF leak can often (but not always) be fixed.

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