Cerebrospinal fluid leak
A cerebrospinal fluid leak (CSFL) is a medical condition where the cerebrospinal fluid in the brain leaks out of the dura mater. This can be due to a spontaneous cerebrospinal fluid leak or result from different causes such as a lumbar puncture or physical trauma. While high CSF pressure can make lying down unbearable, low CSF pressure due to a leak is often relieved somewhat by lying flat on the back. The most common symptoms of a CSF Leak are high pressure in the head when sitting up right, standing or bending down which lessens when laying down flat. Simply put it feels like your head is going to explode, when you do those three simple daily activities. A CT Myelogram (Lumbar spine) can be done in which dye is injected to further enhance the imaging to see the location of the leak. Depending on if it is a slow leak it may not appear on a Myelogram so more than one may need to be done. Anesthesia is not commonly used because it is considered a easy procedure by some so only local anesthetic is given. Blood patches are the normal treatment for a CSF Leak, the patients blood is taken from their arm/hand and it is then injected into the lumbar spine. Patients are told to lie flat without moving from 2 hours to 24 hours after the blood patch is done. Blood patches can be done in the cervical neck if that is where the leak is located although it is rare for it to be done in that location. It may take more than one blood patch to fully close the leak. Anesthesia is not commonly used for a lumbar blood patch, local anesthetic is mostly used. If you have a low pain tolerance it would be a good idea to have anesthesia for all of the procedures. If the leak is strong or fast, the loss of CSF fluid can cause the brain to drop inside the skull due to the bodies inability to replenish the CSF fluid at a quick enough pace, this would show up on a MRI of the brain. This is called a Arnold–Chiari malformation where the brain is lower in the skull into the spinal canal.
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