Cerebrospinal fluid (CSF) acts as a shock absorber for the Central Nervous System.Its primary function is to provides support and cushion the brain within the skull . Leakage of Cerebrospinal fluid through the meninges during or after a spinal tap lead to low-pressure headaches. CSF leakages cause brain displacement down the skull stretching the adjacent tissues and nerves resulting in a headache. A recent study reports that low pressure headaches occur in 10% people who suffered from spinal taps. Additional causes of low pressure headaches include cysts and injury to the meninges. It is imperative to visit an ENT physician if you are suffering recurrent headaches and a stiff back after or without a spinal tap. The blog discusses some of the symptoms, diagnosis and treatment for low CSF pressure headaches.
Symptoms
Low-pressure headaches are acute and accompanied by stiffness in the neck and nausea. The pain usually triggers while a patient is sitting or standing upright and disappears when lying flat. The headaches generally don’t occur during early in the morning hours but gets worst shortly after getting out of the bed.
Diagnosis
An MRI of the brain with injected contrast dye reveals the enhancement of the meninges lining of the brain. It may sometimes indicate the evidence of brain sagging downward from the neck to the skull. Lesser known symptoms involve one or more of the following imaging tests:
CT Myelogram
A CT scan of the back is done by injecting dye into the spinal fluid. CT Myelogram may directly reveal the site of the leak.
CSF Cisternogram
The medical test may reveal the leak directly or may only give an indirect evidence of the presence of the leak though it may not reveal the exact location of the leak.
Magnetic Resonance Imaging
MRI scan of the neck and back to check fluid leakage from normal locations.
Treatment
The preliminary treatment includes pain relievers and increased fluid intake to enhance the production of Cerebrospinal Fluid. Avoiding upright postures and lying flat also helps in relieving the pain. An ENT physician may suggest some secondary treatment such as epidural blood patch if the problem persists. If the headache persists, a small amount of blood is injected into the spine at the close or exact location of the leakage at the lower back of the patient. The process slows down the CSF leakage and provides instant relief from the symptoms. The medical practitioner can repeat the procedure if required. If the patient suffers from critical cases of CSF leakage, it needs to be addressed by a proficient ENT physician or neurosurgeon.
The Way Forward
Recurrent headaches and back pain can be a cause of CSF leakage and shouldn’t be ignored or self-medicated. There are certain CSF leakage instances that don’t show any signs such as nasal drip and vomiting. You need to contact your ENT physician or health care provider if you notice any of the symptoms of CSF leak. Surgery, however, is rarely required to treat CSF leak.Further Read: A Runny Nose Could be a Sign of CSF Rhinorrhea
