Severe headaches, especially when you're upright; chronic migraines that don’t respond to medication; and new persistent headaches may signal a cerebrospinal fluid (CSF) leak.
While CSF leaks are often misdiagnosed, Duke neuroradiologists are among the few experts in the country skilled at finding and repairing CSF leaks. Our comprehensive evaluation often identifies CSF leaks in people whose symptoms have not responded to conventional treatment. Our experience treating CSF leaks makes it possible for people to obtain relief from symptoms they’ve lived with for years, sometimes even decades.
What Is a CSF Leak?
Cerebrospinal fluid can leak through a tear in the dura, the dense tissue that surrounds the brain and spine. The tear can result from:
- A traumatic injury
- Placement of an epidural catheter for childbirth or pain management
- Rubbing against a spinal disc or arthritic facet joint
Often, there is no known cause.
The tear and resulting leak of cerebrospinal fluid can cause lower-than-normal pressure in the protective cushion of fluid around the brain and spinal cord. This is called intracranial hypotension. The low pressure leads to chronic headaches and other debilitating symptoms including:
- Severe headaches, especially when upright
- New persistent headaches that occur daily
- Double or blurry vision
- Ringing in the ears or hearing loss
- Swallowing difficulties
- Facial pain
If You Experience These Symptoms
Because these symptoms may indicate a variety of neurological concerns, CSF leaks are often misdiagnosed. If you are experiencing these symptoms and have not found relief through standard medical treatments, consider evaluation for a spinal CSF leak.
Seek Care from a Neuroradiologist
Duke neuroradiologists specialize in using high-resolution CT, MRI, and CT fluoroscopic imaging to diagnose and treat CSF leaks and other conditions that affect the brain, spine, head, and neck.
Duke Health offers locations throughout the Triangle. Find one near you.
Tests for CSF Leaks
Duke neuroradiologists perform a physical evaluation and conduct a thorough medical history to obtain more information about your symptoms. One or more of the following tests may be performed to check CSF pressure and to confirm a CSF leak along the spine or base of the skull.
A contrast dye is injected into your spinal canal via a lumbar puncture with a tiny needle under CT fluoroscopic guidance. Images are acquired and analyzed to look for the site (or potential site) of a CSF leak.
Magnetic Resonance (MR) Myelography
This can be performed without contrast in order to look for signs of a leak without any intervention.
MR myelography can also be performed to find a leak that has not been detected by CT. This may require the injection of MR contrast into the spinal sac before imaging.
MRI of the Brain
This can reveal brain abnormalities that may indicate CSF fluid loss. This should be performed with and without contrast and should include sagittal images of the brain. A small percentage of people with CSF leaks will have a normal MRI of the brain, so additional imaging is often needed.
Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2020–2021.
Why Choose Duke
One of the Few Centers that Treat CSF Leaks
Duke is one of the few centers in the country with the expertise to diagnose and treat CSF leaks that cause chronic headaches and other neurological symptoms. Our advanced training, experience, and large number of procedures contribute to our excellent results.
Since 2006, Duke neuroradiologists have been national leaders in developing techniques to diagnose and treat spinal CSF leaks. Experts from other centers in the U.S. and around the world consult Duke for training in diagnosing and treating these leaks.
A Team of Specialists
Our neuroradiologists collaborate with neurologists, neurosurgeons, and orthopaedic surgeons to coordinate the best treatment for your condition.
We see 400 to 500 people with spinal CSF leaks every year. People travel to Duke from across the U.S., Canada, Europe, Asia, Africa, Australia, and New Zealand in search of an accurate diagnosis and treatment for CSF leaks.