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cerebrospinal fluid (CSF) leakage
Pathology:
- sagging of the brain within the cranial vault
Clinical manifestations:
- orthostatic headache is main clinical feature
- muffled hearing is common
- cranial nerve palsies may occur
- other variable features include:
- stupor, encephalopathy, parkinsonism, ataxia, bulbar weakness,
Laboratory:
- CSF glucose may be useful for distinguishing sweat from CSF, in patients with suspected leakage of CSF from a ventriculostomy
- beta-2 transferrin in body fluid
- beta-2 transferrin (tau transferrin), seen on high resolution CSF protein electrophoresis of nasal fluid or aural fluid is specific for CSF leakage
- see ARUP consult [3]
Special laboratory:
- lumbar puncture
a) CSF opening pressure low in ~2/3 of patients
b) CSF protein is variable
c) CSF cell count is variable
Radiology:
- magnetic resonance imaging (MRI) with gadolinium enhancement may show
a) diffuse, homgeneous, dura mater thickening & enhancement
b) engorgement of the dural venous sinuses
c) enlargement & enhacement of the pituitary
d) evidence of brain sag
1] subdural fluid collection
2] buckling of the optic chiasm
3] compression of the midbrain
4] crowding of the posterior fossa
5] descent of the cerebellar tonsils, resembling Chiari malformation
- indium-111 labeled cisternography may show the presence of CSF leakage if MRI is negative
- CT myelography is the most sensitive measure of CSF leakage
Management:
- neurosurgery consult
- bed rest & hydration is effective for many patients
- if symptoms persist, autologous epidural blood patch is the treatment of choice
Related
beta-2 transferrin in body fluid
cerebrospinal fluid
Specific
cerebrospinal fluid (CSF) rhinorrhea
CSF otorrhea
General
sign/symptom
References
- Medical Knowledge Self Assessment Program (MKSAP) 15,
American College of Physicians, Philadelphia 2009
- Contributions from Carl Van Gundy, Dept. of Medicine, UCSF Fresno
- ARUP Consult: CSF Leak - Beta-2 Transferrin
The Physician's Guide to Laboratory Test Selection & Interpretation
https://www.arupconsult.com/content/csf-leak-beta-2-transferrin