CSF Leak

KBaird

FNG
Joined
Feb 22, 2020
Messages
38
I’ve lurked here since the beginning, but don’t post much. Have always been impressed with some of the health and wellness knowledge provided on the General forum. Decided I would throw this out there while I wait for further information on my potential condition. Curious if there’s any first hand experience with cerebrospinal fluid leaks and/or maybe even a neurologist in the house?




I’ll try to keep my situation short, but here’s a quick synopsis. Have suffered from some highly unusual, but very persistent, headaches for 5-6 months. Cut out everything I could think of one step at a time before seeking medical advice. Started with nicotine/alcohol, caffeine, onto sugars, and lost ~15lbs in the last six weeks when I really focused on the diet. Nothing helped whatsoever. Headaches persisted, depression/anxiety were at all time highs, and by November I started to experience some quick bursts of vertigo/dizziness. My mother and her sister both passed in their mid 40’s from brain tumors (I’m 37). So I was convinced that was my fate as well!




My wife and I were scheduled for a two week vacation in Mexico with some of her family over the holidays. I talked to my doc at home finally and he agreed getting some imaging done down here would be a great idea. (We live on an island in Alaska and getting an MRI done means flying somewhere anyway). So the first day down here I had head and lumbar pics taken for about $600usd cash. Two days later we lined up an hour consultation with a neurosurgeon, for $50usd, lol! He talked my wife and I through nearly every image and we learned a ton. No tumors or other abnormalities, until he claimed to be able to see with “90% certainty” I had about 1/3 of what he would consider normal CSF in my brain. Referencing the lumbar pics he also claimed to be able to see where fluid was leaking. He ordered more head pics with contrast and a myelogram (spinal CT with contrast) to verify leaks and then started talking about procedures. We pumped the brakes and decided we aren’t real excited about needles in my spine down here. I trust the neurosurgeon as he seemed incredibly knowledgeable and genuine, but the folks in the imagining department not so much. Anyway, plan is to head home with this information and get the ball rolling in the states. Reading some experiences and intel on different hospitals/docs in the states though, it seems this can be a very complicated/drawn out battle for many with inconsistent treatment results.




So while I have another week to marinate on this in Mexico, and who knows how long before we can get some further details in the U.S., I figured I’d toss it out here to see if there was any first hand experience with a CSF leak condition? Wondering how it might affect an active lifestyle with a lot of heavy lifting, from heavy packs in the mountains to hard manual labor (I commercial fish for a living). Also any doctor/facility experience would be welcomed.
 
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Sizthediz

WKR
Joined
Nov 22, 2021
Messages
573
I'm sorry about your situation.praying it's nothing. I'll preface by saying I'm NOT. Dr. I work in medical imaging
So the way xrays work is when they hit hard or dense things they don't penetrate that's why a bone is white and say air in lungs is black. So the contrast used for ct scan and myelogram is "denser" than your blood and other tissue and CSF so when rays hit it anywhere there is blood will show up bright shades of gray or white. If the radiologists see an abnormality in your pictures (ct scan) they look to see if it has contrast in it. If it does that means whatever it is has a blood supply. So they use it to help rule things in or out , ok. Cancer has a blood supply benign things don't. As for myelogram they inject the contrast into your spinal canal under local anesthesia and fluroroscopy(live time imaging) so they can tell exactly where needle is going. They will then have you roll around and then do a ct or mri . Essentially evaluating your spinal canal.
Ct contrast when injected into you MAY make you feel warm/flush/hot all over may give you a funny taste in your throat and also make you feel like you're peeing or pooping. Even though this seems abnormal IT IS NOT So DONT panic. It's very quick. Make sure you don't have an allergy to iodine (shellfish DOESN'T count) and keep hydrated before and after procedure. Contrast can affect kidney function. It naturally leaves your body but a little extra h20 after won't hurt. Good luck . I wish you well.
 

TaperPin

WKR
Joined
Jul 12, 2023
Messages
3,591
Canadians, and there are a lot of Canadians visiting Mexico, have their medical coverage extended to include Mexican doctors so they are good for profits - same for Americans paying cash. It is very common to suggest issues that allow quick “treatment” while you’re there. Not saying the $50 neurosurgeon, wasn’t worth the $50, just suggesting he may not be worth more than that. My in-laws used to spend half the year in Mexico and have a personal friend dentist who makes more money in Mexico than she did in the US selling procedures to tourists.
 
OP
K

KBaird

FNG
Joined
Feb 22, 2020
Messages
38
Canadians, and there are a lot of Canadians visiting Mexico, have their medical coverage extended to include Mexican doctors so they are good for profits - same for Americans paying cash. It is very common to suggest issues that allow quick “treatment” while you’re there. Not saying the $50 neurosurgeon, wasn’t worth the $50, just suggesting he may not be worth more than that. My in-laws used to spend half the year in Mexico and have a personal friend dentist who makes more money in Mexico than she did in the US selling procedures to tourists.



Had that exact scenario in mind before going into the meeting with him. I’ve had some dental work done down here in the past, with positive results luckily, so not a total newb in that regard. He did provide a compelling synopsis, but I’ll head back to the states for confirmation. We’ve got multiple formats of the images to take home and at least something to investigate now that seems to line up almost exactly with my symptoms. Plus a little peace of mind he didn’t see a tumor. So all in all I’m glad we went as far as we did.





No shortage of Canadians doing the same things for sure!
 
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waspocrew

WKR
Joined
Apr 2, 2022
Messages
932
Location
MT
Were they proposing a blood patch as a fix? I seem to recall blood patches for CSF leaks during residency (I'm a dermatologist, not a neurosurgeon or neurologist), but the CSF leaks were usually due to procedures (epidurals, spinal taps, etc).


I'd probably be looking for a second opinion first. You can have your imaging reviewed as well and if they agree, you probably need some more imaging performed to actually narrow down the area (if it's truly a leak).

Hopefully you can get this squared away soon!
 
OP
K

KBaird

FNG
Joined
Feb 22, 2020
Messages
38
Were they proposing a blood patch as a fix? I seem to recall blood patches for CSF leaks during residency (I'm a dermatologist, not a neurosurgeon or neurologist), but the CSF leaks were usually due to procedures (epidurals, spinal taps, etc).


I'd probably be looking for a second opinion first. You can have your imaging reviewed as well and if they agree, you probably need some more imaging performed to actually narrow down the area (if it's truly a leak).

Hopefully you can get this squared away soon!


He was describing an arthroscopic fibrin sealant process. Since talking to him I’ve read that the blood patches are the most common course of action in the spine, but he said this was less invasive?






He certainly wanted more pictures before any decisions. He wanted a better look at my head to rule out any leaks there (which I wasn’t going to have to pay for, so maybe he wasn’t completely milking me, haha) as he said leaks in the skull are increasingly common since Covid. And then he wanted the myelogram to verify leak(s) he was seeing in the lumbar.





Second opinion when I get home is the next course of action for sure. Thanks for the responses and well wishes guys.
 
Joined
Jul 30, 2019
Messages
849
Let me preface this by saying, yes, I am a physician, but I am not giving you medical advice.

The clinical diagnosis is Spontaneous Intracranial Hypotension......... otherwise known as a spontaneous cerebral spinal fluid leak. I have seen two patients in my career who presented exactly as you described and work up resulted in this diagnosis. I actually wrote a case report while in residency on this very subject and presented it at the PGA (Post-Graduate Assembly in Anesthesiology) so I am familiar with it. Wouldn't call myself an expert but I have seen two cases of it.

It's not a prevalent diagnosis but it usually presents in your 40-50s. It is exactly as you describe, a whole in the dura (tissue lining around the spinal cord that holds in the CSF). Generally, this spontaneously occurs though it can be associated with connective tissue disorders (so don't automatically assume you now have a connective tissue disorder, but it may be something to also rule out). Basically, this occurs in the absence of trauma to the spine.

All of the symptoms you report accurately describes how this presents. Classic sign is that your symptoms improve or resolve when lying flat, worsen when upright. What do you do about it.

Conservative management is the first line option. Strict bed rest is key. Lying flat, only getting up to use the restroom and eat. This, in my opinion is the number one reason why conservative treatment often fails because people can't/won't do this. In addition, aggressive hydration, and moderate caffeine intake also are recommended. This treatment typically works for most who are very strict at following it. Doesn't sound like your lifestyle will accommodate for that.

2nd line would be an Epidural blood patch as mentioned above. This, in my opinion, is extremely effective. However, after the blood patch is placed you have to lay flat and take it easy. Bed rest is key yet again, in addition to hydration. If the 1st blood patch fails, a 2nd one can be performed and typically is very successful.

Of the two patients I have treated with this, one of them had resolution with the first blood patch. The 2nd patient failed the 1st and 2nd blood patch and ended up requiring a surgical closure, which is your last treatment and most invasive treatment option. Some will also attempt injecting a fibrin glue surgically over the leak if the blood patches don't work before moving on to the surgical closure. In my experience, if your leak/whole is significantly large, a surgical closure really may be your only option.

One thing to at least be aware is there may be a direct correlation to flying with spontaneous leaks. My first patients occurred while in flight. There are several additional case reports who all reported the same. Similarly, some suggest being at elevation may also be a contributing factor. I haven't seen any recent data regarding "flying" or being at "elevation" to say with certainty it is or is not an inciting event. Maybe just coincidental I don't know but it is an ongoing theme with these per the literature.

Since you have a leak, ANY strenuous/physical activity in the least will continue to cause symptoms once you have a leak. Doing anything other than lying flat in bed will not help and likely make it worse. I would get started on going through the treatment options asap and see if you can get it resolved. You have no idea how easy of a fix this can be and how much better you will feel once its fixed. If a surgical closure is the last-ditch effort or the only real option due to location or size of the leak, I personally would not hesitate at all to get it repaired. Living in the misery you are currently experiencing for the rest of your life is not something I would agree to.

Educate yourself and look for centers with great options/staff/physicians to help your get on a road to recovery.

Best of luck to your sir.
 
Last edited:
OP
K

KBaird

FNG
Joined
Feb 22, 2020
Messages
38
Let me preface this by saying, yes, I am a physician, but I am not giving you medical advice.

The clinical diagnosis is Spontaneous Intracranial Hypotension......... otherwise known as a spontaneous cerebral spinal fluid leak. I have seen two patients in my career who presented exactly as you described and work up resulted in this diagnosis. I actually wrote a case report while in residency on this very subject and presented it at the PGA (Post-Graduate Assembly in Anesthesiology) so I am familiar with it. Wouldn't call myself an expert but I have seen two cases of it.

It's not a prevalent diagnosis but it usually presents in your 40-50s. It is exactly as you describe, a whole in the dura (tissue lining around the spinal cord that holds in the CSF). Generally, this spontaneously occurs though it can be associated with connective tissue disorders (so don't automatically assume you now have a connective tissue disorder, but it may be something to also rule out). Basically, this occurs in the absence of trauma to the spine.

All of the symptoms you report accurately describes how this presents. Classic sign is that your symptoms improve or resolve when lying flat, worsen when upright. What do you do about it.

Conservative management is the first line option. Strict bed rest is key. Lying flat, only getting up to use the restroom and eat. This, in my opinion is the number one reason why conservative treatment often fails because people can't/won't do this. In addition, aggressive hydration, and moderate caffeine intake also are recommended. This treatment typically works for most who are very strict at following it. Doesn't sound like your lifestyle will accommodate for that.

2nd line would be an Epidural blood patch as mentioned above. This, in my opinion, is extremely effective. However, after the blood patch is placed you have to lay flat and take it easy. Bed rest is key yet again, in addition to hydration. If the 1st blood patch fails, a 2nd one can be performed and typically is very successful.

Of the two patients I have treated with this, one of them had resolution with the first blood patch. The 2nd patient failed the 1st and 2nd blood patch and ended up requiring a surgical closure, which is your last treatment and most invasive treatment option. Some will also attempt injecting a fibrin glue surgically over the leak if the blood patches don't work before moving on to the surgical closure. In my experience, if your leak/whole is significantly large, a surgical closure really may be your only option.

One thing to at least be aware is there may be a direct correlation to flying with spontaneous leaks. My first patients occurred while in flight. There are several additional case reports who all reported the same. Similarly, some suggest being at elevation may also be a contributing factor. I haven't seen any recent data regarding "flying" or being at "elevation" to say with certainty it is or is not an inciting event. Maybe just coincidental I don't know but it is an ongoing theme with these per the literature.

Since you have a leak, ANY strenuous/physical activity in the least will continue to cause symptoms once you have a leak. Doing anything other than lying flat in bed will not help and likely make it worse. I would get started on going through the treatment options asap and see if you can get it resolved. You have no idea how easy of a fix this can be and how much better you will feel once its fixed. If a surgical closure is the last-ditch effort or the only real option due to location or size of the leak, I personally would not hesitate at all to get it repaired. Living in the misery you are currently experiencing for the rest of your life is not something I would agree to.

Educate yourself and look for centers with great options/staff/physicians to help your get on a road to recovery.

Best of luck to your sir.


Wow, truly appreciate the time involved on a response like this. Exactly what I needed.


In hindsight the travel days down here weren’t great. Knowing what I do now I’ll pay closer attention on the way home. Also, cutting out the caffeine honestly correlates fairly closely to when the dizziness probably set in. Since learning that I’m back to a coffee or two the last couple mornings. And you’re right, the lifestyle doesn’t lend itself to much r&r. If it was from a trauma around the time the headaches started I probably haven’t sat still long enough for anything to heal.
 
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RO1459

FNG
Joined
Jun 13, 2020
Messages
67
My wife just finished having her CSF leak repaired at Vanderbilt Hospital in Nashville with excellent results. As the Theringworm stated, be very careful with what you do...including flying. Her surgeon told us the she was not to lift anything, try not to cough heavily, not to blow her nose, bend over lowering her head below her waist and no flying. She was told that if she didn't have the repairs done it could lead to meningitis. The outpatient surgery only took about 90 minutes and they did use a patch to repair the tear. Her healing time was about two weeks but her headaches stopped in around five days. Her follow-up showed a successful repair of the leak.

If when you get home and confirm that you do have a CSF leak, from what we were told, I would not wait too long before having it repaired. It's not something to brush aside. BTW, it was covered 100% by our insurance.

Best wishes.
 
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