Spontaneous Cerebrospinal Fluid Leak - Diagnosis

Diagnosis

The primary place of first complaint to a physician is a hospital emergency room. Up to 94% of those suffering from SCSFLS are initially misdiagnosed. Incorrect diagnoses include migraines, meningitis, and psychiatric disorders. The average time from onset of symptoms until definitive diagnosis is 13 months. A study found a 0% success rate for proper diagnosis in the emergency department.

Diagnosis of CSF leak can be done through various imaging techniques, chemical tests of bodily fluid discharged from a head orifice, or clinical exam. The use of CT, MRI, and assays are the most common types of CSF leak instrumental tests. Many CSF leaks are occult and do not show up on imaging and chemical assays, thus such diagnostic tools are not definitive to rule out CSF leaks. A clinician may often depend upon patient history and exam to diagnose, for example: discharge of excessive amount of clear fluid from the nose upon bending over, the increase in headache following a Valsalva maneuver or the reduction of headache when the patient takes a prone position are positive indicators.

As most candidates for CSF leak do not have access to imaging and laboratory tools (modern medicine), clinical exam is the most often used means to diagnose CSF leaks. Improved patient response to conservative treatment may further define a positive diagnosis. The lack of clinician awareness of the signs -symptoms and ailments- of a CSF leak is the greatest challenge to proper diagnosis and treatment, in particular: the loss of the orthostatic characteristic of headache and that every chronic CSF leaker will have a unique symptom set which as a whole contributes to the underlying condition, and diagnosis of, a CSF leak.