Coronavirus (COVID-19) & Cerebrospinal Fluid (CSF) Leaks

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Covid-19 Coronavirus CSF Leak Association Banner

Note: This page will be kept under review and amended if/when government or expert guidance is updated. Updates will be printed in blue text. Last updated: 24 March 2020.

Many of our members and community members have raised concerns about the ongoing coronavirus pandemic (COVID-19) and whether or not people with CSF leaks, both cranial and spinal, and those with cerebral shunts, are at an increased risk of catching the virus or having more severe illness if they get the virus.

We have consulted with our Medical Advisory Committee in light of revised government guidance that now advises those at ‘higher risk’ to practice social distancing, and their feedback is included in this statement. The definition of higher risk currently includes being older than 70, having some underlying health conditions and being pregnant.

As of 23 March 2020, only essential travel outwith the home for food, health reasons or essential work is now advised in the UK; the vast majority of people have been told to remain in their houses and avoid contact with anyone from outwith their immediate home group. 

COVID-19 is a novel virus and as such there isn’t a large body of evidence to draw from and this outbreak is an evolving situation. There is currently no clear evidence to suggest that having a CSF leak or a shunt, on their own, puts a person at higher risk. This virus predominantly affects the lungs and, if severe, it is known to cause cardiac issues.

We would, however, urge each of you to carefully consider your overall health status, including your age, smoking status and other separate health conditions you may have (including high blood pressure, heart disease, lung disease, cancer or diabetes) when considering what steps you plan to take to manage your risk of contracting the virus.

Please also be aware that there are a number of health conditions known to co-occur in some people who have or have had a CSF leak (e.g. connective tissue disorders, postural tachycardia syndrome (PoTS), mast cell activation syndrome (MCAS) and intracranial idiopathic hypertension (IIH)) and if you are affected by any of these conditions, we would urge you to seek advice from condition-specific organisations who have issued their own statement in relation to COVID-19 or your medical team; you must consider your own health status in the round.

If you have specific concerns about your individual health then it would be best to speak with your doctor and follow the government or health service-issued guidance relevant to where you are.

Regardless of how stringently each of us chooses to follow the social distancing guidance, we can all do our part by practising good hygiene practices, isolating as and when necessary, keeping in virtual contact with each other and sharing only trustworthy information and advice about COVID-19.

Please also consider your mental health and emotional well-being at this time and don’t forget to take a break from the news from time to time. It is important for us all to keep abreast of current NHS and government guidance, but it is equally important for us to maintain perspective.

The mental health charity, Mind, has some useful information that might help: www.mind.org.uk/information-support/coronavirus-and-your-wellbeing

Finally, everyone involved with the CSF Leak Association wishes you all the best in these coming months. Disruption to NHS services will no doubt affect many of us as the UK’s four health services mount a response to the outbreak; if we successfully ‘flatten the curve’ this outbreak will still be with us for some time.

Although nobody can predict with any certainty how mild or otherwise their illness will be if they get COVID-19, we know that many people with CSF leaks report that even common colds and flu (particularly with associated coughing) can make their symptoms harder to cope with. If you rely on pain or other regular medication, please make sure that you contact your GP surgery to make sure you have what you need.

Please also don’t be shy about asking your friends or family for help during any period of self-isolation and if you’re in the unfortunate position of being in isolation without your usual support network, there are local support groups springing up all over to help out. We would, however, urge you to exercise caution when dealing with any external organisations that are not formally registered as charities or healthcare providers, as they may not be subject to the same level of scrutiny or regulation.

Here are few links and resources that you may find useful:

If you believe that you may be experiencing symptoms of Covid-19/Coronavirus, you must follow the latest NHS/government guidelines and, amongst other things, self-isolate. If you are not located in the United Kingdom, advice for your country may vary slightly.

New Spinal CSF Leak Imaging Factsheet

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Imaging Quick Reference Factsheet FB Advert 1

Quick Reference Guide to Spinal CSF Leak Imaging Techniques

We we delighted to have been able to release our brand new factsheet on imaging techniques to coincide with both Day Three of Leak Week UK and global Rare Disease Day 2018.

The guidance provides a brief overview to most of the common imaging techniques that diagnosed or suspected spinal CSF leak sufferers will encounter on their diagnostic and treatment journeys.

It was prepared with significant professional input and should answer many of the common questions that patients have about the different scans that they’re put forward for.

You can download your own copy of the publication by clicking here.

 

Measuring Opening Pressure & Intracranial Pressure

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CSF Leak Association Factsheet Series Advert - Opening Pressure on Lumbar Puncture

Measuring lumbar puncture opening pressure is common practice during spontaneous CSF leak and intracranial hypertension investigation and diagnosis. Less common, but still widely used at some institutions is the practice of looking out for low intracranial pressure via ICP monitoring.

Both confirmed and potential CSF leak sufferers often query how pressure is measured, the differences between opening pressure and intracranial pressure recording, and what ranges constitute normal, low and high pressure. In response, we’ve produced a CSF leak-specific factsheet.

Our updated factsheet explores the key ins/outs of measuring opening pressure by lumbar puncture and provides details on the common pressure ranges in tabulated form. Also covered are the basics of CSF production and absorption.

We have updated the factsheet in response to feedback and also referenced a number of new and additional journal articles, including two important publications which confirm that ‘normal’ opening pressure is not an uncommon occurrence with spontaneous CSF leaks.

Download the factsheet here: Measuring Opening Pressure & Intracranial Pressure

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

Measuring Opening Pressure on Lumbar Puncture

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CSF Leak Association Factsheet Series Advert - Opening Pressure on Lumbar Puncture

Measuring lumbar puncture opening pressure is common practice during CSF leak and spontaneous intracranial hypertension diagnosis.

Many confirmed or potential CSF leak sufferers often query how pressure is measured, the differences between opening pressure and intracranial pressure recording, and what ranges constitute normal, low and high pressure.

Our new factsheet explores the key ins/outs of measuring opening pressure by lumbar puncture and provides details on the common pressure ranges in tabulated form. Also covered are the basics of CSF production and absorption.

The importance of using non-cutting needles for lumbar puncture procedures, in order to reduce the risk of post-dural puncture headache and persistent CSF leak, is also highlighted.

Download the factsheet here: Measuring Opening Pressure & Intracranial Pressure

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