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Cerebrospinal Fluid (CSF) Leaks

Cerebrospinal fluid (CSF) is a clear mixture of water and electrolytes circulating around the brain and spinal cord. A disruption in the brain lining, or in the bone separating the brain from the sinuses, may result in the drainage of cerebrospinal fluid into the nose. Many times the drainage will appear as a noticeable clear nasal drip when leaning or bending over. A CSF leak is a very serious condition because it can lead to meningitis which is an infection of the cerebrospinal fluid and the lining covering the brain.


At least 5 of every 100,000 people will develop a CSF leak each year, but the condition is thought to be under diagnosed.1 A CSF leak can be debilitating and potentially life-threatening, but it is also difficult to correctly diagnose. Houston Rhinologist Dr. Arjuna Kuperan has the skill and experience to accurately diagnose and treat CSF leaks. As a Board Certified Otolaryngologist (ENT), Dr. Kuperan specializes in nose and sinus issues.


CSF is primarily produced in the choroid plexus (an area within the brain) and is continuously replenished. This clear fluid surrounds the brain and spinal cord and serves as a cushion against injuries and also delivers nutrients to the brain.

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A CSF leak results from several different causes. Some patients have unexplained elevated intracranial pressure which over time causes the bone between the brain and sinuses to remodel and become thinner ultimately leading to a CSF leak. Other patients get a CSF leak from hitting their head or face during a traumatic accident which causes a fracture of the thin bone separating the brain from the sinuses. In rare cases, patients getting sinus surgery can suffer a CSF leak if an inexperienced surgeon has accidentally penetrated through the thin sinus bones while operating.

People with certain conditions, including hypertension, Ehlers-Danlos syndrome and Marfan syndrome, are at greater risk for a CSF leak and women typically experience CSF leaks more often than men.2


  • Severe headaches in the upright position, which alleviate while lying down.
  • Watery postnasal drip that has a salty taste.
  • Clear watery nasal drainage from only one side of the nose that is worse when getting up from a seated or lying down position.
  • New onset neck stiffness.

You should seek immediate medical attention if you have any symptoms of a CSF leak. Be sure to let your medical provider know if your symptoms are worse when seated or standing and feel better when you lay down, as this is a key characteristic of a CSF leak. The fluid that drains from the nose can be collected and tested to see if it contains beta-2 transferrin, a protein unique to CSF.


Dr. Kuperan will use diagnostic tools, such as a CT scan (x-ray) of your sinuses and nasal endoscopy to assess your condition in order to create a treatment plan. The nasal endoscopy can show where specifically the leak is coming from and the CT scan can visualize any fractures of the bone between the brain and the sinuses.

If there is a small leak a lumbar spinal drain can be placed to decrease the intracranial pressure. In this case, Dr. Kuperan would monitor you to see if the CSF leak spontaneously resolves.

A CSF leak that is severe or does not resolve after lumbar drain placement may require surgery to correct. Since the fluid leaking is clear it may be difficult to differentiate from ordinary mucus produced in the nose. In these cases, a dye called fluorescein can be injected into the CSF space through a lumbar spinal drain that turns the clear fluid into a yellow/green color. This technique localizes the CSF leak very efficiently. Once the source of the CSF leak is identified, the defect can be closed by performing a very technically specialized procedure called a cerebrospinal fluid (CSF) leak repair.

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Dr. Kuperan is dedicated to providing effective and personalized treatment for patients in Houston. CSF leaks require an accurate diagnosis and detailed treatment plan from an experienced physician. You can count on Dr. Kuperan for thorough and thoughtful treatment. Contact us with any questions or to schedule an appointment.

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1 Cedars-Sinai. Knowing the Signs of a CSF Leak. Available: https://www.cedars-sinai.org/blog/signs-of-csf-leak.html Accessed February 16, 2023
2 The Cleveland Clinic. Cerebrospinal Fluid (CSF) Leak Available: https://my.clevelandclinic.org/health/diseases/16854-cerebrospinal-fluid-csf-leak Accessed December 14, 2020.

Dr. Arjuna Kuerpan has either authored or reviewed and approved this content.

Houston Advanced Sinus