cerebrospinal fluid (CSF) leakage

Pathology

• sagging of the brain within the cranial vault

Clinical manifestations

• orthostatic headache is main clinical feature
• muffled hearing is common
• cranial nerve palsies may occur
• other variable features include:
  • stupor, encephalopathy, parkinsonism, ataxia, bulbar weakness,

Laboratory

• CSF glucose may be useful for distinguishing sweat from CSF, in patients with suspected leakage of CSF from a ventriculostomy
• beta-2 transferrin in body fluid
  • beta-2 transferrin (tau transferrin), seen on high resolution CSF protein electrophoresis of nasal fluid or aural fluid is specific for CSF leakage
• see ARUP consult

Diagnostic procedures

• lumbar puncture
  • CSF opening pressure low in ~2/3 of patients
  • CSF protein is variable
  • CSF cell count is variable

Radiology

• magnetic resonance imaging (MRI) with gadolinium enhancement may show
  • diffuse, homgeneous, dura mater thickening & enhancement
  • engorgement of the dural venous sinuses
  • enlargement & enhacement of the pituitary
  • evidence of brain sag
    • subdural fluid collection
    • buckling of the optic chiasm
    • compression of the midbrain
    • crowding of the posterior fossa
    • descent of the cerebellar tonsils, resembling Chiari malformation
• indium-111 labeled cisternography may show the presence of CSF leakage if MRI is negative
• CT myelography is the most sensitive measure of CSF leakage

Management

• neurosurgery consult
• bed rest & hydration is effective for many patients
• if symptoms persist, autologous epidural blood patch is the treatment of choice

More general terms

• sign/symptom

More specific terms

• cerebrospinal fluid (CSF) rhinorrhea
• CSF otorrhea

Additional terms

• beta-2 transferrin in body fluid
• cerebrospinal fluid