Severe headaches, especially those that occur when you're upright and that start abruptly, may signal a spinal cerebrospinal fluid (CSF) leak, also known as spontaneous intracranial hypotension.
While spinal CSF leaks are often misdiagnosed, Duke neuroradiologists are among the few experts in the country skilled at finding and repairing spinal CSF leaks. We have extensive experience treating CSF leaks, even in people who have not had success with other treatments. Our experts help people find relief from symptoms they’ve lived with for years, sometimes even decades.
What Is a Spinal CSF Leak?
Cerebrospinal fluid can leak out from around the spine due to a hole in the dura, the dense tissue that surrounds the brain and spine. The hole can result from:
- A tear caused by a bone spur
- An abnormal connection that forms with a nearby vein
- A traumatic injury
- Placement of an epidural catheter for childbirth or pain management
The tear and resulting leak of cerebrospinal fluid can cause you to lose the protective cushion of fluid around the brain and spinal cord. Low cerebrospinal fluid pressure leads to chronic headaches and other debilitating symptoms including:
- Severe headaches, especially when upright
- New persistent headaches that occur daily, often starting abruptly
- Double or blurry vision
- Ringing in the ears or hearing loss
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 fluoroscopic imaging to diagnose and treat CSF leaks and other conditions that affect the brain, spine, head, and neck.
CSF leak care is provided at Duke University Hospital.
Evaluation for CSF Leaks
Duke neuroradiologists perform a physical exam and conduct a thorough medical history to obtain more information about your symptoms. The following tests may be performed to check CSF pressure and to confirm a CSF leak along the spine.
MRI of the Brain
Usually one of the first tests performed, a brain MRI can reveal abnormalities that may indicate CSF loss. A contrast dye injected intravenously (via an IV) helps highlight these abnormalities on the scan. In a small percentage of people, additional imaging is needed.
CT Myelogram or Dynamic Myelogram
Through a lumbar puncture and with imaging guidance, a contrast dye is injected into your spinal fluid via a tiny needle. Then your entire spine is imaged. The dye helps identify leaking fluid and pinpoint the site of a CSF leak.
Treatment Options for Spinal CSF Leaks
When conservative treatments such as bed rest and hydration don’t relieve symptoms, a procedure is often required to repair a CSF leak. Depending on the cause of the leak, one of these customized treatments may be recommended. Recovery can take several weeks. After your procedure, our team will contact you often to monitor your progress.
Your own blood or, in some cases, a type of surgical glue is used to create a patch that seals the leak. With CT fluoroscopic guidance, the blood and/or glue is injected adjacent to the tear or potential site of the leak. If the precise location isn’t known, one or more patches may be placed. This procedure is performed after you are given medication to help you relax and to reduce pain.
If the leak is caused by the sharp edge of a bone spur rubbing against the dura, a spine surgeon can repair the leak and remove the spur causing the problem.
Venous Fistula Surgery
Sometimes a loss of cerebrospinal fluid occurs due to CSF draining too quickly into the venous system through an abnormal blood vessel connection called a fistula. A neurosurgeon can treat the leak by disconnecting the abnormal vein.
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 2021–2022.
Why Choose Duke
One of the Few Centers That Treats 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 and international leaders in developing techniques to diagnose and treat spinal CSF leaks and in researching spontaneous intracranial hypotension. Experts from other centers in the U.S. and around the world consult Duke for training on these subjects.
Nurse Coordinator to Help Navigate Your Care
Our nurse coordinator becomes your one-stop shop for coordinating referrals, sharing appointment and procedure instructions, and communicating with your doctors. They make your CSF leak treatment journey easier by guiding you through it step by step. And they are available to answer all of your questions along the way.
We receive more than 500 referrals to evaluate spinal CSF leaks every year. People have traveled 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.