The symptoms of chronic cerebrospinal fluid (CSF) leak, also referred to as spinal fluid leak, are similar to those of many chronic pain syndromes including fibromyalgia, migraines, chronic neck pain, fatigue (ME/CFS), and a form of dysautonomia called POTS (Postural Orthostatic Tachycardia Syndrome).
What is CSF (Cerebral Spinal Fluid)?
The brain and spinal cord should not rub against bone. In order to keep this from happening, there are three layers of protective tissue similar to plastic wrap, called the meninges, which lie in between these critical central nerves and the bones. The dura mater is the thickest of the three.
Normally, the brain, spinal cord, and spinal nerve roots are floating in fluid which is contained underneath the dura and arachnoid layers. Usually, the body seals a tear or hole in the meninges, specifically the dura, just like it would heal cuts and abrasions on the skin. But sometimes these holes don’t heal on their own. Especially when the onset is slow or gradual, a CSF leak will often go unrecognized and symptoms can be attributed to other causes.
How could a spinal fluid leak start?
Spinal fluid leaks can be caused by a variety of reasons. Primary risk factors include:
- Prior spine procedures including epidural injections, spinal taps, or surgeries such as discectomy or fusion;
- Trauma, from relatively mild whiplash injuries to more severe trauma such as motor vehicle accidents, falls, or fractures;
- Narrowing of the spinal canal, including Chiari malformation, spinal arthritis, spinal stenosis, or Tarlov cysts;
- Connective tissue diseases such as Marfan syndrome, hypermobility syndrome, Ehlers-Danlos syndrome, or a history of aneurysm.; and,
- Spontaneous leaks with no specific precipitating event. Unfortunately, some people are born with thin lining (meninges) of the spinal nerves and are therefore more prone to a spinal fluid leak.
What are the symptoms?
The most common symptom of a cerebrospinal fluid leak is a severe headache which is worse upon standing up. However, when a spinal fluid leak is chronic the symptoms may also include neck pain, fatigue, hearing abnormalities, blurred vision, and nausea. These problems may increase throughout the day or when dehydrated. Sometimes, symptoms are increased with bending, coughing/sneezing, and bowel movement.
What is the treatment?
In the past, the primary treatment for spinal fluid leak was a blood patch, a procedure that injects a person’s own blood in order to “patch” the leak. However, this sometimes resulted in irritation of the spinal nerves by red blood cells. To avoid this, a more effective treatment, which we offer at the Kaplan Center, is PRP (Platelet Rich Plasma) injection.
I have seen great success using PRP to treat patients who have ultimately been diagnosed with CSF leak. Considering how debilitating a spinal fluid leak can be, the treatment is relatively simple. After a blood draw, a centrifuge is used to separate red blood cells from PRP which is then injected into the spinal area. A local anesthetic numbs the area prior to injection. The PRP has many growth factors and cytokines which send signals to cells in the body to plug the leak.
For more information about PRP treatments and other regenerative medicine treatments, please visit https://kaplanclinic.com/service/regenerative-medicine/.