CSF, otherwise known as Cerebrospinal Fluid is a see-through, colorless liquid that pads the brain. This liquid flows through the ventricles in the brain. CSF is an essential fluid that keeps the cerebral tissue from injury and infections. The brain continuously produces CSF and reabsorbs it back into the blood system. Although a cerebrospinal fluid leak is uncommon, the CSF can leak through the brain covering and into the nose area. Leaks are usually due to a fracture in the skull, feebleness of the brain covering (dura), intracranial surgery or development of a brain tumor. CSF leaks can also be linked to meningoencephalocele - this is a uncommon condition that is present at birth. Essentially, the brain and its lining (meninges) protrude through a opening in the base of the skull). Occasionally leaks happen in overweight individuals who have a high amount of cranial pressure. This is because the membrane between the brain and sinus "pops open." Sometimes, a head injury or car accident can produce a tear. This condition can be very dangerous and these leaks must be mended in order to avoid an infection of the CSF (meningitis) or of the brain in general (brain abscess).
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).
Treatment plans include two options. It can be either surgical or medical. In situations of spontaneous CSF leak or head injury, moderate treatment is frequently suggested at the start. Depending on what caused the leak, many of symptoms can improve by themselves, after just a couple of days. Thorough bed rest for several days is typically recommended. Patients are advised to avoid sneezing, heavy lifting, and coughing. Taking stool softeners prevents straining.
Surgical treatment of CSF leaks is a method that is used when moderate treatment methods fail. 20 years ago, cerebrospinal fluid (CSF) leaks were often handled surgically, through external (scalp) incisions and craniotomies (opening the bone of the skull with a saw). The insertion of the nasal endoscope tool and other specialized instruments has allowed effective treatment through the nose for many of these issues, completely sidestepping any incisions on the scalp and face. These "endoscopic" methods minimize the amount of discomfort for the individual and reduce hospital stays. Endoscopic treatment requires particular training of the ENT surgeon as well as their team.
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