Could this be a CSF leak?

[Catharine]

My fiancee is a 38-year-old man who experienced a fractured skull, and lung and knee damage due to an accident (explosion) in the late 80s. Some time in the early to mid 90s he started experiencing severe headaches on the left frontal side of his head, and also the discharge of very large amounts of very clear, watery drainage from his nose. He doesn't remember if these symptoms started at the same time as the headaches or just around the same time. The headaches are debilitating and not helped much even by several doses of prescription narcotics.  Also antihistamines do not help the drainage unless a very large amount are taken. He has been worked up by a neurologist with MRIs, etc. The neurologist knows of these nasal symptoms and diagnosed him with cluster headaches (he also has watering of the left eye during the headache), but he is not sure he has ever had his nasal secretions tested for CSF. My questions are these:
1) Could this be a CSF leak? The skull fracture was on the forehead area, not in the spinal area.
2) If this is indeed suspicious for CSF, how is this tested for? I seem to recall in my work (I am a med. transcriptionist) that patients' secretions were tested with some sort of "litmus paper" type of thing. If so, is this something we could buy at a pharmacy and test ourselves, or will a doctor need to see him first? (We are not against seeing the doctor, but want to save a trip to find this out if possible.)
3) Generally, how are CSF leaks treated? I have read in your archives about "blood patches," but I'm not sure what these are.

Thank you.

[CCF-Neuro-M.D.-JT]

1) Possible, yes. It is well known that skull fractures can cause CSF leaks that look like watery discharge from the nose. This can occur when there was a tear in the meninges (tissue covering the brain) that occurred with the fracture, leading to a CSF leak.
2) An easy test that we do in the hospital is to check the drainage for glucose (sugar) with a little strip diabetics use to check their glucose level. If it's positive for glucose, then it's CSF as nasal mucus contains no glucose. Not sure if this is a do-it-yourself kind of thing (would recommend going to a doc), but I'm sure if you were really motivated to do so, you can buy the equipment at the drug store. Probably pricey.
3.Blood patches are used for spinal leaks (in the back) such as from back trauma, epidurals or spinal taps. That's when the patient's own blood is injected into the area where the tear is to "clot it off." For skull fractures, usually they go away on their own.  But for persistent leaks, surgical repair of the torn meninges may be needed.  

I agree with your concern. CSF leaks from a skull fracture can lead to repeated bouts of meningitis, so if this is a consideration I would talk to your neurologist or seek a second opinion. GOod luck.

[CYNDY]

Just wondering has he ever had a lumbar puncture (spinal tap) to test the pressure of his spinal fluid.  You may want to look up symptoms of pseudotumor cerebri.
Good Luck

[csd1`35r]

Catherine, it sure could be a CSF leak.  I know someone who had the same problem.  It wasn't until the drainage happened in the doc's office that they were able to 'follow' the flow and see that there was a tear.  I think it was behind the septum, but am not sure.  It was an ENT that found it.

Colleen

[c.light]

I had a spontaneous CSF leak in 2000 that lasted for about 6 months.  The headaches were indescribable.    I did not have any drainage, but my pressure was so low that it did show up on an MRI as a thickening of the dura around the brain and spinal cord.  Although the doctors expected the leak to resolve spontaneously, I did have a test called a cisternogram done to try to locate the source of the leak. (They did not find my leak).  The test invlolves injecting a small amount of a radioactive dye into your spine and then following it over the course of a day or two as it circulates around your spinal cord and brain.  Part of the test involves putting these papers way up your nose which they them pull out and test for CSF.  Anyhow, I developed a rather large bleed and had to have an emergency craniotomy after 6 months of low pressure, so although my situation was uncommon, if you suspect low CSF, I would ask for more tests.

[spinner4488]

what was your CSF leak from?  I had a  spinal tap 2 weeks ago and my doctor will not give me a blood patch because my headaches didn't start until 4 days after the spinal tap.  If I had a leak I would of had headaches right away.  He says my headaches are tension headaches.  My headaches are in the bottom left side of my brain and only feel better when I lay  down.  I am on a bunch of differnent kinds of meds. that I take at bedtime.  Anyone????

[c.light]

Hi.  I don't know if you'll see this, but my headaches were in the back of my head (both sides) and felt like my brain was being crushed.  Laying down made it feel better immediately (better to the point that it seemed incomprehensible that I could be in so much pain when upright). I did have a blood patch after a spinal tap (done at the time of a cisternogram), but my headache from the tap started the very next day.  The blood patch did offer some relief, but in my case, it did not correct the underlying problem. Good luck and I hope that you feel better soon.

[t_anunson]

Hi C.light, we`ve correspnded a little before I think. I began having neurological symptoms 6 1/2 mos. ago after birth of 1st child. I remember that you had sort of the same situation. I still have no diagnosis.... Have you found anything out yet? Or have a diagnosis? Thanks...

[c.light]

I have been having neuro problems since my baby was born in last August.  This third episode has lasted nearly 3 months and involves tingling/burning in both feet and sometimes all over both legs.  My tendons burn and feel sore and tight.  Now my ankles hurt (not badly, just annoying and not normal for me).  I will be going back to the neurologist for the sixth time on the March 24 (would've gone on 3/13 but I couldn't get a babysitter).  So far all tests normal, I think that this time I am going to have lumbar puncture.  My neuro thinks it's some "benign process" that will resolve spontaneously.  The neuro on this forum thinks that I should have an EMG to look for a peripheral neuropathy.  We'll see.  I'll let you know if I find any new.

Colleen

[t_anunson]

I had my daughter on Aug. 15, 02. I`ve had tingling, numbness, tendon tightness, fasiculations, cramping muscles, eye pain, and my legs seems to pop forward when walking sometimes. Hands and feet have both been involved in tingling/numbness. I also have a cold patchy tingly feeling when I`m setting on the couch bent over. MRI of breain and C-Spine were taken 4 mos. ago and were normal. Blood and exam also normal. NCT was normal. I`m going to see another neurologist Mon., I`ll let you know what he says. I had an epidural w/ vaginal delivery. Did you take the epidural? Have u had problems with your hands or arms? Take care....

[t_anunson]

Whats your email? I`d like to compare problems....

[c.light]

Hello.  My email is ***@****.

Colleen