Cerebrospinal Fluid Leaks: An Overview

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We are delighted to announce the publication of Cerebrospinal Fluid Leaks: An Overview, the latest edition to our popular factsheet series. It is free to download from our website.

This new leaflet provides a valuable overview of cerebrospinal fluid (CSF) csf-leak-association-factsheet-series-advert-csf-leaks-an-overviewleaks, both cranial and spinal, and touches upon key signs and symptoms, diagnostic techniques and treatment options.

It has been produced in consultation with two UK neurologists working in the NHS: Dr Simon Ellis, a consultant neurologist at Royal Stoke University Hospital, and Dr Manjit Matharu, a consultant neurologist at the National Hospital for Neurology and Neurosurgery.

Cerebrospinal Fluid Leaks: An Overview is a must-read for both diagnosed sufferers and those who suspect that they may be suffering from a CSF leak. It is ideal for inclusion in leaflet displays or handing out as part of an awareness-raising event.

The leaflet also provides useful information for GPs, doctors working in emergency medicine, paramedics and other healthcare professionals who may not routinely encounter CSF leaks in their work, but nonetheless need to know what to look out for and how to treat them.

Download the leaflet here: Cerebrospinal Fluid Leaks - An Overview

Detection of CSF Leak in Spinal CSF Leak Syndrome Using MR Myelography

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Schematic drawing of 4-point-scale grading system of CSF leak on MRM (A) and RIC (B). A, Our grading scale on MRM is depicted as follows: grade zero, no leak (normal findings on MR myelogram); grade 1, possible leak (expansion of the CSF space column around the nerve root sleeve); grade 2, probable leak (streaky hyperintensity lateral to the nerve root sleeves but with length less than the transverse diameter of the thecal sac); and grade 3, definite leak (lateral extension greater than the transverse diameter of the thecal sac). However, actual grading of the case is determined on the basis of the highest grade in each level of the spine. B, Grade of CSF leak on RIC is depicted as follows: grade zero, no paraspinal activity; grade 1, possible leak (faint paraspinal activity with length under the transverse diameter of spinal canal activity); grade 2, probable leak (hot paraspinal activity with the length under the transverse diameter of spinal canal activity); and grade 3, definite leak (hot paraspinal activity with the length over the transverse diameter of spinal canal activity)‏

Full article and PowerPoint presentation available here: http://www.ajnr.org/content/29/4/649/F1.expansion.html

Headache Journal: Spontaneous Cerebrospinal Fluid (CSF) Leaks

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Spontaneous cerebrospinal fluid (CSF) leaks typically present with orthostatic headaches. Less commonly, spontaneous CSF leaks can present with other headache types. Nausea, vomiting, hearing disturbances, diplopia, back pain, and dizziness are not uncommon associated symptoms. Although the exact cause of CSF leaks often remains uncertain, some patients may be predisposed due to disorders of connective tissue or spinal meningeal anomalies.

When a spontaneous CSF leak is suspected, head MRI with contrast is ordinarily the first study to obtain. Common abnormalities seen include diffuse dural enhancement, subdural fluid collections, engorged cerebral venous sinuses, and cerebral descent. Important to know is the fact that despite typical clinical features, head MRI may occasionally be unremarkable. In such situations, ancillary studies may help answer whether a CSF leak is present. Radioisotope cisternography and spine MRI are helpful tools in such occurrences. Presently, CT-myelography remains the most reliable test to find the exact spinal CSF leak site. Often, however, the exact CSF leak site is not found.

Read the full article here: http://www.headachejournal.org/view/0/CSFLeaks.html

Health: How spinal condition lead to crippling headaches

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Struggling off the bus in agony, Deborah Ogg barely knew what was happening.

She had never suffered from headaches, but suddenly she was in such excruciating pain that she had to lie down in the street, utterly overwhelmed.

Her worried partner Peter looked on, helpless, and even the taxi driver he summoned offered to take them straight to hospital. But Deborah, 40, hating to make a fuss, insisted on going home to bed.

“I felt like somebody had hit me over the head with an iron bar,” she recalls, “It was massive pain.”

The pharmacist recommended migraine pills, but they didn’t help. “I tried getting up to go to the toilet but as soon as I got up the pain was even worse and I was on my knees, I just crumpled,” she says.

It was April 1 last year, and the start of a long and painful journey with what she eventually discovered was a rare condition called cerebrospinal fluid (CSF) leak.

Affecting around one person in 50,000, it occurs when the fluid, which cushions the brain and spine, leaks out through a hole in its protective sac. This results in a drop in pressure, so that the brain can no longer float in fluid.

The brain cannot feel pain, but the resulting “brain sag” pulls on tendons and muscles across the head, causing extreme pain, which is slightly relieved when sufferers lie down.

It is most common after epidurals or spinal operations, but in some cases, such as Deborah’s, occurs spontaneously, which makes treatment harder, because the location of the leak is not known.

Read the full article here: http://www.edinburghnews.scotsman.com/news/health/health-how-spinal-condition-lead-to-crippling-headaches-1-2150059