Spontaneous Cerebrospinal Fluid Leak - Signs and Symptoms

Signs and Symptoms

Most people who develop SCSFLS feel a sudden onset of a severe and acute headache. It is a headache usually but not necessarily orthostatic in nature, typically becoming prominent throughout the day, in which usually the pain is worse when the person is vertical and less severe when horizontal. Other symptoms include dizziness and vertigo, facial numbness or weakness, unusually blurry or double vision, neuralgia, fatigue, a metallic taste in the mouth, nausea, or vomiting. Leaking CSF can sometimes be felt or observed as discharge through the nose or ear. Orthostatic headaches can be incapacitating; these ailments often become chronic and can be sufficiently disabling to make those afflicted unable to work. Some patients with CSF leak will develop headaches that begin in the afternoon. This is known as second-half-of-the-day headache. This may be an initial presentation of CSF leak or appear after treatment and likely indicates a slow CSF leak.

Lack of CSF pressure and volume allows the brain to descend through the foramen magnum, or occipital bone, the large opening at the base of the skull. The lower portion of the brain is believed to stretch or impact one or more cranial nerve complexes, thereby causing a variety of sensory symptoms. Nerves that can be affected and their related symptoms are detailed in the table at right.