What are the symptoms of a CSF leak?

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What are the symptoms of a CSF leak?

When CSF leaks are small enough that they don’t noticeably affect your brain, you may not notice any symptoms or might mistake the symptoms for something else. When a CSF leak is large enough that it causes intracranial hypotension, you’ll have symptoms related to pressure on the lower areas of your brain.

The most common symptom of intracranial hypotension from a CSF leak is a postural headache, which means a headache that changes depending on your posture. A postural headache with a CSF leak worsens when you sit up or stand and improves when you lie down.

Symptoms that depend on CSF leak location

Some possible symptoms of CSF leak depend on the location of the leak. Two likely places that CSF can leak into are your sinuses or your nose. In either case, you’ll have a runny nose (rhinorrhea) with thin, clear fluid. CSF coming out of your nose has two key differences from nasal mucus:

  • If you wipe your nose with a handkerchief, drying nasal mucus will cause the cloth to stiffen, but CSF won’t.
  • The runny nose may happen under certain circumstances, such as when you bend over to pick something up or tie your shoes.

Another place where leaking CSF can cause symptoms is your ears. Clear fluid coming out of your ears (otorrhea) is a symptom of a CSF leak. However, it's less likely to happen because for the fluid to leak out, you'd also have to have a hole or tear in your tympanic membrane (also known as your eardrum).

Other possible symptoms that happen with or because of a CSF leak

  • Loss of sense of smell (anosmia). This usually happens with a CSF leak due to an injury to your face.
  • Blurred or double vision (diplopia). This can happen when downward pressure on your brain causes problems with the ocular nerves, which connect to your eyes.
  • Changes in hearing or hearing loss. This happens for similar reasons as double vision, with position changes putting strain or stress on the nerves connected to your ears.
  • Pulsatile tinnitus. This is being able to hear your own pulse without using some kind of medical instrument or other means.
  • Seizures. These are most likely to happen with large CSF leaks or those that cause severe intracranial hypotension.
  • Neck pain and stiffness.
  • Loss of appetite.
  • Headaches, which can sometimes be severe or even unbearable.
  • Dizziness or vertigo.
  • Nausea and vomiting.
  • Photophobia (light sensitivity).
  • Balance and gait problems.

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