Liquorrhea or CSF leak is the leak of cerebrospinal fluid that provides nutrition and metabolism in the brain. Normally, the cerebrospinal fluid is located between the membranes of the brain and the bones of the skull, as well as in the ventricles of the brain (its cavities) and in the area between the spinal cord and the spine bones. Its leak is caused by fractures of the skull or spine, neurosurgical operations, accompanied by rupture of the dura mater, being firmly symphysic with the bones of the skull.
Possible ways for the leak of cerebrospinal fluid (cerebrospinal fluid that provides nutrition and metabolism in the brain, resembling a clear oily fluid):
- the nose, while the person can consider it nasal mucus. Liquor excretes mainly from one nostril, most actively when the head is flexed forward;
- the ears, especially when the head is flexed to the side;
- the defects of the bones of the skull or spine;
- sometimes, there is a leakage of cerebrospinal fluid mixed with blood, when CSF leak is a consequence of traumatic brain injury;
- dull headache: associated with a decrease in the liquor pressure in the skull;
- cough: occurs when liquor flows into the respiratory tract (most often during sleeping).
Depending on the manifestations, there are 2 forms of the cerebral spinal fluid leak:
- a clear cerebrospinal fluid is secreted from the nose and ears;
- hidden (nasal) – the phenomenon of liquorrhea is hidden since the CSF is constantly swallowed and cannot be diagnosed.
Depending on the place of fluid leakage, the following forms of fluid are distinguished:
- nasal – CSF expired from the nose associated with damage to the bones of the skull in the anterior cranial fossa, most often in the ethmoid sinus;
- hidden – a cerebrospinal fluid is excreted out of the ears which fact is associated with a fracture of the temporal bone pyramid;
- wound – cerebrospinal fluid flows out of a postoperative wound;
- spinal – CSF excretes from a spinal defect (for example, in case of back injuries).
Depending on the cause of fluid leakage, there are 2 forms:
- primary occurs immediately after the injury, surgery;
- secondary occurs after a period of time as a result of the formation of a fistula.
The main cause specified by My Canadian Pharmacy is the violation of the integrity of the dura mater in combination with a fracture or damage to the bones of the skull/spine.
It may develop in the following situations:
- traumatic brain injury;
- damage to the bones of the ethmoid sinus (located deep in the nose) when ENT manipulations (washing, drainage) are conducted;
- hernia of the spinal cord and brain.
Analysis of complaints and history of the disease:
- how long the first signs of a cerebrospinal fluid leakage appeared – cerebrospinal fluid providing nutrition and metabolism in the brain (constant leakage of clear fluid from the nose, ears);
- what event immediately preceded the appearance of this disorder (head injury, head surgery).
- neurological examination is also required to assess the presence of defects of the skull, spine, leakage of cerebrospinal fluid from the ears or nose, signs of a fracture of the skull.
- value the glucose rate in the leaking fluid: liquor contains a lot of glucose, but it is not enough in the nasal mucus (it makes it possible to distinguish leaking fluid from the common cold).
- sample handkerchief (oil stain): wipe out the fluid with a handkerchief. Liquor, unlike nasal mucus, leaves oil stains on the fabric, and when dried, the leaking fluid remains soft.
- CT (computed tomography) and MRI (magnetic resonance imaging) of the head and paranasal sinuses allow you to study the structure of the brain in layers and determine the presence of damage to the skull bones.
Treatment of CSF Leak
Non-surgical methods include:
- not straining the abdomen, blowing out;
- elevated head position preventing leakage of cerebrospinal fluid;
- diuretic drugs to reduce intracranial pressure, which will reduce leakage of cerebrospinal fluid;
- lumbar drainage: releasing CSF from brain cavities to reduce CSF pressure in the skull;
- antibiotics (prevention and treatment of infection);
- anti-inflammatory drugs (nonsteroidal anti-inflammatory).
Surgical methods offered by My Canadian Pharmacy are:
- surgical treatment of the dura mater defect and skull, hermetic wound closure;
- removal of a cyst of the spinal cord or brain, sewing up the dura mater.