What is Brain Fluid Leak? Symptoms and Treatment for CSF Leak

By Brian Lemay 47 comments


Hi I am Dr. Amber Luong I’m an associate
professor here at the University of Texas Medical School within the
Department of Otolaryngology. What I wanted to talk to you about today is a
cerebral spinal fluid leak or more more commonly called brain
fluid leak and the reason why I wanted to talk to you about this is because of
the fact that this can often be mistaken for allergies and it’s something that I
think that the patients often know better than the physician that there’s
something not quite right. So what exactly is cerebrospinal fluid leak or
we’ll call it a CSF leak or brain fluid leak. Basically it’s when you notice
clear fluid leaking out of your nose. The reason why patients often know that it’s
not quite right or it’s not allergies is that it’s very different from allergies
and the fact that the clear liquid often comes more from one side versus the
other so rather than in allergies where you feel drainage on both sides, brain
fluid leak or cerebral spinal fluid leak is often only on one side. What’s really
interesting about CSF leaks is that you can prompt it or you can get it to start
leaking when you lean over so a patient will describe leaning forward and having
it drip either on the right side or the left side. If by chance it happens to go
to the back of your throat you may notice a slightly metallic, salty taste
to it. And so if you have those symptoms I think that’s when you should start
asking your doctor or thinking about the potential brain fluid leak. So brain
fluid leaks are not very common, in fact they’re not they’re not very common in
general however I get to see a lot of these because I’m over here at the
Medical Center and a lot of these types of diagnoses get referred to me. I’m a
sinus surgeon that does sinus surgery as well as skull base surgery and that’s
working on the area of the bone that separates the brain from the
sinuses. So when you suspect a brain fluid leak, when should you
be worried about it or when do we start worrying about it? Well, there’s pretty
much three typical causes for brain fluid leak. The most
common cause I think almost over 90% of these brain fluid leaks happen after
some sort of trauma, some sort of accident a car accident or other
accidents and it may happen immediately or it can happen several days to even a
couple weeks to months after a an accident to the head. In that situation
if that is the cause or thought to be the cause oftentimes these are treated
with just a lumbar drain or a drain that’s put into the back of your spine
and this takes some of the fluid off of the back to minimize the pressure on the
site where it’s leaking from and allowing it to heal. This may be about
three to five days where the lumbar drain is placed and that often is all
that’s required for that treatment. The other possible cause is after some sort of
a tumor. So a tumor in the brain or in the sinuses can then grow and cause a
hole in that skull base the one that’s separating the brain from the sinuses
and in that situation the key is that we need to know that we need to
treat that tumor and then ultimately that defect can be repaired surgically.
The one that’s really difficult to diagnose and the one where you’ll
probably be involved most in helping us make that diagnosis is the ones that
happen spontaneously. The spontaneous ones are where you don’t have a history
of a tumor, you are not diagnosed with a tumor, you have no history of an
accident. The other cause that I forgot to mention is if you’ve had a prior
sinus surgery or some sort of surgery done on the brain sinus area
that surgery can potential complication is a defect in that skull base causing a
CSF leak but if you don’t have those situations then there is a entity or a
diagnosis where it’s a spontaneous CSF leak. So a spontaneous CSF leak it
happens because we don’t know what the cause is, but what we believe is going on is that
for whatever reason you have an increased intracranial pressure on the
brain fluid. I should back up a little bit to give you a little bit of the
anatomy. So the brain fluid is the fluid that surrounds the brain but the fluid
and the brain is covered by lining called the dura and then that of course
all lives inside your your skull and separating the brain from the sinuses is
this skull base. So in a spontaneous CSF leak there is whatever reason increased
pressure in on the brain fluid and over time and this may be months – maybe
even years we believe this pressure thins out that bone that separates the
brain from the sinuses and it eventually breaks through and creates a hole or a
defect and then once that defect is there then the brain fluid can then leak
into the sinuses ultimately into the nose where you’ll you’ll detect it. And
so those are the most common and again the one that I failed to talk about was
if you have a history of having some sort of sinus surgery or surgery done
into your nose or even brain surgery sometimes there may have been a defect
or a hole that was either undetected or not noticed at the time of surgery that
then can cause a CSF leak. So what do you do or what does a physician do when they
suspect this? Well, first of all the history and physical or the history is
very important so as I mentioned leaking primarily from one side that doesn’t
respond to allergies because oftentimes we as physicians think that it’s ours
because it’s more common and if it doesn’t respond then we start thinking
about maybe a CSF leak or something else that’s going on, we’ll try to collect the
fluid in the clinic. The fluid is collected so that we can look for
whether or not this fluid is in fact brain fluid. What we can look for is a
protein called beta – transferrin so we’ll collect the fluid or have you
collect the fluid for us send it off to the lab for beta to transferrin if it is
in fact positive then it is most likely brain fluid
leaking from your nose. Now the second step will be to try to figure out
exactly where it is leaking from. In order to do that we get imaging studies.
So imaging studies usually consist of a CT scan of the sinuses or head as well
as an MRI. The CT scan allows us to find the bone defect, so CT scans are very
good at looking at the bone structure of the area. Why do we get an MRI? Well
sometimes when you have a hole in your skull base the if the hole is big enough
sometimes parts of the brain can pooch out into this defect and we want to know
that prior to considering any sort of surgical repair. So we get both the brain
CT as well as the brain MRI looking for this pooching also called an
encephalocele. So once we know that the cause, if it is spontaneous, and we know
where it’s leaking from and we’ve confirmed that is in fact brain fluids
that’s leaking then the most common treatment is a surgical repair. These
days oftentimes this surgical repair can all be done through their nose so you
don’t have to have any incisions on your face or on your brain which is a
huge improvement from about 20 years ago. The surgery involves putting a camera
into the nose and basically opening up the sinuses so that we can see where on
the skull base where this hole is and then with the help of a camera we can
then visualize where the actual leak is coming from. So how do we tell where the
leak is coming from? Well when you’re in with your ear nose and throat doctor or
a rhinologist, one of the referrals or other doctors that we’ll have you go see
is a neurosurgeon the neurosurgeon will help us put in a lumbar drain at the
time of surgery. Again that’s that drain that goes into the into your back and
what that allows us to do at the time of surgery is to take a little bit of your
brain fluid and put some dye into it: a yellow bright dye that we put into it
and then we put it back into your spinal fluid and this
then of course circulates around the brain and so now at the time of surgery
that dye highlights where the leak is coming from. So this allows
us to not only confirm that on the CT scan where we think the leak is coming
from we can actually see the leak and this will also help us with our repair
to make sure that we can confirm that there’s no further leaking. So what we do
is once we can see it with the camera and we can see where the defect is we
basically expose the defect and after that it’s just a matter of plugging it
up. So what are the things that we use to plug up this hole? Well we can borrow
some tissue from the lining of the inside of your nose to plug it up. We
sometimes may need to use fat from your abdomen to just kind of plug up the hole
especially when it’s really small or in an area that’s very
difficult to get to or we can sometimes use synthetic material that’s safe to be
put next to the brain. If the hole is very big we may have to put several
layers in it, several layers between the brain and the bone and then the bone
within the sinuses but once we have all those layers in place and we confirm
with our dye that there’s no further leaking then we put some additional
packing on the inside of your nose to kind of support that repair. Often
times you’ll have to be admitted to the hospital somewhere between one to three
days after your surgery with that lumbar drain still in your back. Over the time
that lumbar drain is to kind of take off a little bit of the brain fluid so that
it minimizes the pressure just to help with the healing process and to allow
this area to heal somewhere between one to three days the lumbar drain will be
kept in place. After that the drain will be taken out and then you’ll be allowed
to go home. Probably for the next four to six weeks we’d ask you to kind of
minimize activity, take it easy, try not to exert yourself too much. Again
we’re just trying to minimize the pressure in your brain to help allow
that area to heal. And then at that point you’ll keep
seeing your ENT surgeon back for some routine follow-up just to make sure
that everything is healing properly. If taken care of properly
there should be no problems and oftentimes this heals without any issues
and you don’t require any additional surgery. In some situations people who
have these spontaneous leaks they have this condition that causes their
pressure on their brain to be higher than normal and so you may have a couple
of holes in your skull base or a couple of areas that are weak and at the time
of surgery maybe there was only one area that’s actively leaking but it is
possible that over time there may be other areas that may leak. If that
happens then we may have to go in and do basically the same surgery on that other
spot that’s leaking. That’s very rare but if it does happen we basically go in the
same way and repair it. Now if it happens for the third time we may need to ask
our neurosurgery colleagues to consider some sort of permanent way of decreasing
the pressure off that brain. If you’re concerned about this, about a brain fluid
leak, for either you or your family or just want to learn a little
bit more please feel free to give us a call at the University of Texas
physicians the Department of Otolaryngology. We work hand-in-hand with
our neurosurgical colleagues as well as our surgical team Memorial Hermann Texas
Medical Center where these repairs are done on a pretty regular basis UT Physicians A part of UTHealth Memorial Hermann Texas Medical Center

47 Comments

Jem Lou

Aug 8, 2018, 6:50 pm Reply

What happens if this goes untreated for 2/3 years?

Jodie Mangion

Aug 8, 2018, 4:39 pm Reply

at what age is this common at?

Tuollaf

Aug 8, 2018, 8:58 pm Reply

i think im in the middle of one is because its only coming out of one side its clear liquid. its spontaneous because ive never been in a acident. i have no tumors on my brain and no history with that either.

B2 Fishy

Sep 9, 2018, 5:38 pm Reply

I've been too two different sinus docs and have had two surgery's with no relief. I keep telling them something is wrong. I cant live my life like this anymore and I'm ready to give up. I am always in so much pain. I leak from my nose. Now I am having so many issues. I have a hard time breathing. The place I have been to had me get bloodwork done and that was it. I need help and nobody is listening. They keep telling me allergies but I take allergy pills and nothing works. I just cant do this anymore. I cant give my son the life he needs because I am constantly sick. My nose leaks drops of fluid when I bend down but its liquidy not thick. I'm 32 and I know this isn't normal. My head has so much pressure and it hurts so bad now that I am coughing. Someone Please Help!

Lil Civic

Sep 9, 2018, 1:22 pm Reply

Is it bad that I have this symptom especially at 16? I always that it was mostly older people but my nose has been leaking a lot.

Melonie Miller

Sep 9, 2018, 9:19 pm Reply

Can someone get me an appointment with her? I’m having to drop out of UT due to a severe illness and this is the only thing that makes sense. Have had nasal leakage, ear leakage, everything.

Fifa Labibi

Sep 9, 2018, 11:20 pm Reply

I just had this and I thought I had a bloody nose at first and it run out like water it just happened just a few minutes to me but I never had brain surgery and as far as I know I never have hit my head to cause injury and I never had nose surgery or a brain tumor or any kind of operation done to my brain this is the first time this has ever happened to me that's why I looked it up online to see what caused it to happen because I don't have a cold and as far as I know my allergies are OK when my allergies do kick in that's when the pollen is out and flying through the air then it feels like I have a cold then I take allergy pills for that I am so glad I found you on YouTube and listened to your Channel now I think I will call my doctor and see what she says by any chance could seizures cause this also?

Divya Vaishnav

Sep 9, 2018, 5:24 am Reply

i had an accident like 3 years ago and my head was hitted to the glass of car. at that time immediately water started come out of my nose for almost 1 minute and then stopped automatically. After that i have suffer from that situation again for only 2-3 times when i got cold and fever in these past years. i am so confused, should i need to worry about that?

whitney burkey

Sep 9, 2018, 4:54 pm Reply

My left ear is filling with fluid in a place that shouldn't be,on the inside of my upper cartilage area. Could it be CFS?

Agustín Ignacio Moscoso

Sep 9, 2018, 2:46 pm Reply

This happened to me after chronic sinusitis surgery, I could barely breed from my nose due to polyps and sinus infection. I had sinusitis since I was 8 years old. The doctor had to work a lot inside ( had to remove polyps and making two holes in the ethmoid bones to connect better the sinuses) and ended up provoking a CSF fistula. A risk from surgery. I took two re interventions to seal the dura. The first re intervention was to make a tampon with skin and adipose tissue from my ear, the remaining scar is barely noticeable, since I moved a lot, took a shower in the hospital bedroom ( when I was told to do absolute rest 30 degrees in bed) the tampon moved and leak started again. So they had to do it again but this time instead of using tissue from outside skin they used the turbinates to do the tampon thing and they applied BioGlue. So I had BioGlue, Spongostan and Surgicel inside my sinuses( sirurgy hemostatic materials for faster healing ). All those smell funny and you feel them. Now Im breeding like never before. I have been so interested about all technics along history to solve this problem I regreting studying engineering :P. Quite a fun stuff, not during the process thou, I was scared to death.

If you see the fluid that is rock crystal clear coming from your nose go to the doctor, same thing applies if you feel it coming from behind the throat. If you let time go by you increase the chance of a bacteria like a pneumococcus get inside through the fistula and causing meningitis wich is very dangerous if is not treated soon. You may end up in a wheelchair. That is what I have been told by the doctor.

Oswald McDonald

Oct 10, 2018, 5:59 pm Reply

How can I get in touch with you nurse or doctor I have a sign of situation for 36 years

Sumi tewari

Oct 10, 2018, 4:30 pm Reply

Does brain leak also cause sneezing and congestion?

Stella Artois

Oct 10, 2018, 5:14 pm Reply

The past 3 days I am having clear water like fluid coming out of my right nostril. I am not congested and have no allergies. It does drip faster when I bend over. The left nostril is fine. I called an ENT doctor today and made and appointment for Thursday Nov. 1st. I am a nurse and never had something like this before. I'm kind of scared to find out what it is and I know it is not allergies.

janie camacho

Nov 11, 2018, 8:09 pm Reply

What wasn't said was that if you get an infection, it can go up the opening and get meningitis. That's the dangerous part to expedite fixing the leak.
Thank you Dr. Luong.    I wasn't told that the spinal tap would stay for a couple of days.

Leonardo Luiz

Nov 11, 2018, 11:51 pm Reply

Just learnt about this condition, this is a nope nope condition, along side cancer.

Rabeya Rehman

Nov 11, 2018, 12:14 am Reply

I dont have any history of accident or some surgery etc but for last 15 years i have problem some white color fluid come out from my brain in my thorat some times in my nose and its texture is so stickey what is this can tell me pls

KDM CHICK Bennett

Dec 12, 2018, 2:01 am Reply

I've been trying to get my doctor to pay attention to this I get infusions at my home for dysautonomia three times a week and the leaking is always out of the left side of my nose and when I'm on the ivy it is more study I'm very sick

joella64

Dec 12, 2018, 2:30 pm Reply

I had surgery for this 2 days ago. Head needs to be kept at 30 degree angle. Excruciating headache along with severe congestion. Advised to use saline solution in nose as often as I can tolerate it. This helps clear out the mucous and blood from nose. I cannot life anything over 15 pounds, no bending, no strenuous activity, avoid constipation and anything that causes pressure.

Kassahun Tafese

Jan 1, 2019, 2:30 pm Reply

Thank u for your explanation I have got from the you tube. may I tell you some of my history about my nasal leak before 25 years a go while i was high school student when i study hard such fluid drop out from my noise. the dr. told me this happen due to anxiety. when i took rest there is no more fluid. i quite my education for long about 10 yrs. Then i when i am at university and burden of study, i the drop come out but when i become calm no more. now when read and study little bit hard my head become dizzy, the flue come out it look little yellow, sticky. my whole body loose strength, feel joint weakness.but no headache. what do you comment about this?

jason jackie

Feb 2, 2019, 3:56 pm Reply

Yesterday and day befot yesterday I bent and a fluid fall so today I met a doctor he told it's not csf leak and he said it's allergies

I_only_snipe_u _

Feb 2, 2019, 4:59 am Reply

Im sorry to everyone here… i hole you all get better, god be with you through your troubles

Cyanide Cyan

Mar 3, 2019, 11:59 pm Reply

What if the fluid is stinky? Is it also brain fluid leak?

josie ree

Mar 3, 2019, 5:39 am Reply

Can it come out of your eyes?

PhotoCop

Mar 3, 2019, 6:23 am Reply

I have water falling from my nose for 2 days. I don't have the other symptoms like headache, nausea, vomit. Is it csf? Pls help.
My mom says it's just normal runny nose. Please assure me

Newfie_Mafia_HD

Mar 3, 2019, 2:47 pm Reply

Will the fluid be sticky? I had strange fluid leak once and would run out like water and was sticky, clear but yellowish when on tissue

Dianna Alivia Pele

Apr 4, 2019, 11:32 pm Reply

Huh, there’s no mention of Ehlers Danlos. That’s Wildly negligent

SkelliBones 223

Apr 4, 2019, 8:36 am Reply

Health anxiety anyone ?

cheryl tozer

Apr 4, 2019, 8:01 pm Reply

I was misdiagnosed for 3 months. almost died. Here are my videos of my CSF leak. https://youtu.be/GkazAeeKsPA

Roblox Blaster

May 5, 2019, 1:19 am Reply

So is it a Brain leak if I was sleeping one night and my nose piled up with water and I woke up and could not breathe to well until the liquid came out of my nose?

Schizophrenic Gamer

Jun 6, 2019, 5:15 pm Reply

"the patients often know better than the physicians that there's something not quite right"
Oh how I wish more doctors took this approach, the world would be a much healthier place.

Carragh Doherty

Jun 6, 2019, 10:36 pm Reply

My doctor said it was because I’m over weight can that be the cause ?

meghan dawe

Jun 6, 2019, 6:02 am Reply

I experienced this today, and I’m really hoping it’s just a sinus infection or allergies but I’ve never experienced this before and I’m slightly concerned lol

Zion Gray

Jun 6, 2019, 4:26 am Reply

I beleive i have a cranail leak my mri without contrast showed fluid thickening in my right maxillary sinus and left middle ear…ive been bed ridden with severe innercranial hypertension for months how can i get this diagnosed. No fluid is comming out but i taste saltyness from my sinus in the back of my throat. Who do i need to be refured too? And what scan can diagnose it. my ent and nurologist are not listening to me.

Lama 69

Jul 7, 2019, 2:13 am Reply

You need a contrast ct and mri too

Angawa Pesêderrie

Jul 7, 2019, 5:27 am Reply

it drips alot from my nose

ShadowPerdita

Aug 8, 2019, 5:11 am Reply

Ik a YouTube comment section isn’t the place to put this but this is also the most helpful video I’ve seen on it; I’d gone to a weekend long metal festival and while in the mosh pit I’d been hit on the top of my head really hard, I’d refrained from doing anything strenuous for the rest of that day but later when I’d sat down to collect myself I’d suddenly had a whole bunch of fluid come out of my nose, steadily streaming and dripping, it was brownish orangish no doubt initially from blood but it was so watery, later when the festival was coming to an end I’d, excuse me for lack of a better term, snorted a blob of blood when breathing in through my nose really hard and spat it out, it wasn’t mucous of any kind but rather much more viscous almost jelly like, the days that followed I’d be dripping from my nose until a few weeks later it’d almost entirely stopped, the fluid draining to the back of the throat however I think is still super slight almost imperceptible and as the days go by I keep wondering if it’s actually draining anymore or ever did. The fear of it being a CSF leak though is unnerving to say the least

YOUSIF ASHKN

Aug 8, 2019, 8:48 am Reply

Today i got hit by the couch in the back of my head. And then water came out of my nose i thought it was blood. It's scary

Ludmila B

Aug 8, 2019, 3:00 am Reply

If it will help for someone… My daughter had csf leak from her born. She had leak from left nostril. 6 years all doctors told that it’s running nose, allergy, cold and something else. She had liquid from only one nostril, that liquid was so clear, no smell, solt. When she got meningitis she had mri and ct, and then they are diagnosed some cranial defect. Ent and neurosurgeon doctors repair that defect.

G T

Aug 8, 2019, 3:23 pm Reply

🙋👍😊

Jeffra Page

Aug 8, 2019, 4:28 pm Reply

I don't know what I have but I thought it was a sinus infection I started having really bad sinus headaches on 27th of August then last night I started having clear nasal drainage whenever I bend down kind of looks like water out of one side of my nose really fast.

hannah animates

Sep 9, 2019, 7:34 am Reply

So is this common because everyone here looks like they have it I do I hope not but its coming pretty fast it's clear coming out the right side and its taste salty I had to taste it to make sure my head hurts when it comes out

Glynis R

Sep 9, 2019, 4:12 am Reply

What if the fluid is not coming down my nose….It's happening at the back and could be going down my throat? I do have phlegm in my throat area.

Chad Bates

Sep 9, 2019, 3:05 pm Reply

A few days ago I had the flu, I vomited once, and my muscles aches now I have headaches, they get very bad whenever I stand up but only for a few moments (30s-2min) I don’t have the fluid leaks from anywhere but I do sometimes get dizzy, and lightheaded when standing, is this just the flu or should I be worried

Chakka Kon

Sep 9, 2019, 7:35 am Reply

I was brutally beaten and gang raped. My fluid started leaking out of my ears (drenched pillow) and nose within the week. That was 5 years ago. I just figured this out yesterday!! ALL my newer medical problems now make sense. This was done by people who are very well versed in the medical community.

Muhammad Saeed

Sep 9, 2019, 3:13 pm Reply

I keep feeling pressure in my ears , and a weird fluid (similar to blood taste) taste in my throat.
Feels like there is some fluid in and around my ear. I have headaches quite often especially when l lie down. Sometimes area around my head and ear feels num..

Greenztine

Sep 9, 2019, 2:06 am Reply

It all starts when i got a Dream about a car accident, I woke up and it starts dripping i feel like my head is always heavy like fr.

Deirdre Stewart

Sep 9, 2019, 8:56 pm Reply

Been palmed of with nasal sprays salt taste in mouth told them about the csf not one thing done cranial leak due to head trauma had experienced balance is awful. They tried to say it was vertigo think a person knows there own body my spinal area also effected went to an ent doc who staated it was a neuro issue living hell it effects daily activity fit for nothing they said post nasal drip mine been continuous headaches eye leaky sinus one side blocked due to see a neuro soon but from what i gather and was told nothing can be done been off balance since 2017 fluid pressure in ears muffled hearing woulnt wish it upon anyone but info on this vid helpful

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