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Re: CSF Leak

Posted By CCF Neuro MD on July 10, 1997 at 22:07:33:

In Reply to: CSF Leak posted by Tim Daley on July 02, 1997 at 21:37:43:

Five days after a lamenectomy on L-5 S-1 I developed a CSF leak. After the staples were taken out the fluid flowed freely out of the wound. I was placed in the hospital for 12 days where a blood patch was performed but was unsuccessful. A drain was then placed in my back and an MRI was done to try and pinpoint the leak. The leak was not found. Another surgery was performed to try and locate the leak and remove the drain. The source of the leak was again not found. by this time the headaches had subsided and the leak had stopped. Now about 8 months later I have developed the same symptoms as when the leak had first appeared. Headaches, nausea,  neck pain and diarrhea. These were the symptoms I had Prior to the staples being taken out after the first surgery. This has lasted about two weeks but has since subsided. This is now the third time it has happened  after the second surgery . Subsequent MRI's have been negative. Also when I get a leak there is a lot of swelling in the lower back which is very tender. I also have constant pain in my back. Does anyone have any ideas as to where the leak might be coming from or a way to possibly find the leak?

Hello, Tim,
It sounds like you are suffering from chronic cerebrospinal fluid (CSF) leak. However, the negative MRI is bit bothersome.  Several recently published studies have all shown that MRI is a sensitive diagnostic tool for CSF leak or fistulae (opening) (Clin.Radiol. 51(12):837(1996)).  Other studies, once considered as good standard, such as CT scan with contrast, to some extend, has been replaced by MRI. However, it works as an addtional way of diagnosis especially when the others turn out to be negative.   Usually surgical repair is considered if the symptoms are not resolved upto two weeks.  In your case, patch and surgical repairs resulted in resolution for months.  This makes one think whether we are still dealing with the same condition even though the symptoms are similar.  A serial of negative MRI makes the situation even more suspecious.  Therefore, I think the best way to approach your problem at this point is to consider further investigation using the other modelities as discussed; and in the meantime, to have a full neurological evaluation to find out if other causes are present.  To do so, you need to visit a referral center.  If you happen to be in the Cleveland area in the near future, or decide to come here for a visit, feel free to call our department at (800)223-2273 or local (216)444-2200 asking for ext. 45559 for an appointment at your convenience.  Good luck on your recovery.
  This information is provided for general medical education purposes only.  Please consult your primary physician for the diagnosis and treatment options for your specific medical condition.

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