CSFLecks

CSFLecks is a term occasionally used to describe leaks of cerebrospinal fluid (CSF) from the cranial or spinal subarachnoid space. In most clinical literature, CSF leaks are discussed without the combined form CSFLecks, but the term appears in some glossaries and patient education materials to emphasize the leakage of CSF from its normal containment.

Causes and mechanism: CSF leaks can be spontaneous, result from trauma, or occur after medical procedures such as lumbar puncture, skull base or spinal surgery, or other iatrogenic events. A defect in the dura mater or skull base allows CSF to escape into nasal or ear passages or into the surrounding tissue. This loss of CSF can lead to decreased intracranial pressure and compensatory changes that may contribute to symptoms. The leak may be persistent or intermittent, and its location (cranial base, spinal canal) influences presentation and management. Complications can include meningitis if pathogens access the CSF.

Symptoms and signs: The hallmark symptom is an orthostatic headache that worsens upon standing and improves when lying down. Other features may include neck stiffness, nausea, photophobia, tinnitus, and a clear nasal or ear discharge that may test positive for beta-2 transferrin, a marker of CSF.

Diagnosis: Diagnostic workup combines clinical evaluation with imaging and laboratory tests. Imaging options include MRI or CT cisternography, myelography, or intrathecal contrast studies to identify the leak site. Beta-2 transferrin testing of drainage can help confirm CSF origin. Clinicians also assess for signs of intracranial hypotension and meningitis.

Treatment and prognosis: Conservative measures such as bed rest, hydration, caffeine, and analgesia are often attempted initially. Epidural blood patching is a common non-surgical treatment, while persistent leaks may require surgical repair or dural reconstruction. Most CSF leaks resolve or can be controlled with treatment, though recurrence occurs in some cases. Early management reduces the risk of infectious complications and other sequelae.