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What Is a Cerebrospinal Fluid (CSF) Leak?

To protect your spinal cord and brain, these organs are surrounded by clear spinal fluid. This fluid is known as cerebrospinal fluid, or CSF, and contains glucose, protein and many things that are also present in your blood. A cerebrospinal fluid leak is a condition that occurs when the CSF leaks through a hole on the covering of the brain, the dura, and flows out into the nose or ear.

A hole or tear on the dura can result after a head injury, brain injury, sinus surgery or after lumbar puncture, which is also known as a spinal tap. Spontaneous cerebrospinal fluid leaks can also occur for unknown reasons. Individuals with high-pressure hydrocephalus, an unusual accumulation of cerebrospinal fluid, also may be at a higher risk of developing CSF leaks.


The most common signs of a cerebrospinal fluid (CSF) leak are:

  • Positional headaches, which get worse when sitting upright and better when lying down
  • Neck pain or stiffness
  • Nausea
  • Vomiting
  • Sense of imbalance
  • Pain between the shoulder blades
  • Ringing in the ears
  • Photophobia (sensitivity to light)
  • Phonophobia (sensitivity to sound)

For individuals with cranial CSF leaks, the most common signs are:

  • Drainage from the nose or ear
  • Sense of drainage down back of the throat
  • Salty taste in the mouth
  • Change in hearing or ringing in the ears
  • Loss of sense of smell (anosmia)
  • Cutaneous sinus tract drainage


The definite diagnosis of CSF leaks includes both physical examination and laboratory analysis.

During the physical examination, the patient will be asked to lean forward to observe if this position produces an increase in the flow of nasal discharge. The discharge is then collected for laboratory tests to determine if it is cerebrospinal fluid. The nasal fluid is analyzed for a protein called beta-2 transferrin, which is most only found in cerebrospinal fluid.

Diagnostic tests such as computed tomography (CT), magnetic resonance imaging (MRI) scans and cisternogram should also be performed to determine the severity and location of the CSF leakage. Specialized tests such as myelography, which takes images of the spinal cord, spine and surrounding organs, are also done to show any abnormalities.

A pledget test may also be carried out. It involves putting small cotton pads (known as “pledgets”) into the nose. This test confirms the presence of a CSF leak, but it cannot determine the precise location of the leak.


Many CSF leaks heal on their own and require only a period of bed rest, avoidance of strenuous activity and nose blowing. However, if symptoms of the condition persist, it is crucial to consult a doctor immediately due to the increased risk of meningitis that is associated with cranial CSF leaks.

Need More Information?

At Houston Advanced Nose & Sinus, all patients with CSF leaks receive an accurate diagnosis and treatment plan. Our primary treatment involves Endoscopic Surgical CSF Leak Closure where the hole or tear between the brain and nasal cavity is sealed with some tissue from within the nose. Our experienced rhinologist, Dr. Kuperan, will ensure the treatment is a success. Patients are discharged in one or two days and we also do close follow-ups to ensure that the nasal cavity heals well. Contact us today for the best treatment.

We’re here to help

If you are frustrated by frequent sinus infections, persistent nasal congestion, or other sinus symptoms, Dr. Arjuna Kuperan and the team at Houston Advanced Nose & Sinus can help. Contact us today with any questions or to schedule your consultation.

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