Cerebrospinal fluid leak - Revision history

Aidan at 18:07, 11 November 2022

2022-11-11T18:07:48Z

← Older revision		Revision as of 18:07, 11 November 2022
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	*CSF leaks are associated with a high risk of meningitis (10-25%, depending on etiology and chronicity)		*CSF leaks are associated with a high risk of meningitis (10-25%, depending on etiology and chronicity)
	*May be spontaneous, traumatic, or post-neurosurgical		*May be spontaneous (may be a cause of [[idiopathic intracranial hypotension]]), traumatic, or post-neurosurgical
			*Spontaneous leaks are more common in overweight or obese patients

			== Clinical Manifestations ==

			* May follow head trauma or skull-base surgery
			* Symptoms of [[IIH]], including headache, visual defects, and [[pulsatile tinnitus]]
			* Symptoms of low ICP, including orthostatic headache and nuchal rigidity
			* CSF rhinorrhea
			** Typically unilateral and watery
			** Typically triggered by changes in posture

			== Investigations ==

			* Beta-2 transferrin or beta trace protein, which is positive in CSF
			** Best way to differentiate CSF from normal rhinorrhea
			* High-resolution CT of the sinuses and skull base without contrast
			** Looking for defects in lateral lemella/olfactory cleft/ethmoid roof, roof of the lateral recess of the sphenoid sinus, supraorbital ethmoid roof/frontal sinus posterior table, and planum sphenoidale and posterior wall of sphenoid sinus and temporal bone
			* High-resolution MRI to assess the area of suspected leak as well as signs of [[IIH]]
			* Imaging may show suggestive signs: empty sella, arachnoid pits, erosion of skull base, widening of the subarachnoid space around the optic nerves, tortuous optic nerves, posterior globe flattening, dilated Meckel cave
			* May need MRV (or CTV) to exclude a transverse venous sinus stenosis

	==Management==		==Management==

			*Per consensus guidelines, the following assessments are recommended:
			**All patients with suspected CSF rhinorrhea should have ENT exam including nasal endoscopy and otologic exam
			** May benefit from ophthalmologic assessment for papilledema as well as assessment of visual fields
	*Current IDSA guidelines[[CiteRef::tunkel201720]] recommend:		*Current IDSA guidelines[[CiteRef::tunkel201720]] recommend:
	**No routine prophylactic antibiotic in patients with basilar skull fractures and CSF leak		**No routine prophylactic antibiotic in patients with basilar skull fractures and CSF leak
	**Surgical repair if leak lasts more than 7 days		**Surgical repair if leak lasts more than 7 days
	**Pneumococcal vaccination		**Pneumococcal vaccination
			*International consensus guidelines suggest:
			**If CSF rhinorrhea is proven, they should undergo closure
			**Patient should be counselled on risk of meningitis
			**No routine prophylactic antibiotics

	==Further Reading==		==Further Reading==

			*International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea. ''Int Forum Allergy Rhinol''. 2021;11(4)794-803. doi: [https://doi.org/10.1002/alr.22704 10.1002/alr.22704]
	*Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. ''Clin Infect Dis''. 2017;64(6):e34-e65. doi: [https://doi.org/10.1093/cid/ciw861 10.1093/cid/ciw861]		*Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. ''Clin Infect Dis''. 2017;64(6):e34-e65. doi: [https://doi.org/10.1093/cid/ciw861 10.1093/cid/ciw861]

Aidan at 23:41, 19 October 2020

2020-10-19T23:41:32Z

← Older revision		Revision as of 23:41, 19 October 2020
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	==Background==		==Background==

	* CSF leaks are associated with a high risk of meningitis (10-25%, depending on etiology and chronicity)		*CSF leaks are associated with a high risk of meningitis (10-25%, depending on etiology and chronicity)
			*May be spontaneous, traumatic, or post-neurosurgical

	==Management==		==Management==

	* Current IDSA guidelines recommend:		*Current IDSA guidelines[[CiteRef::tunkel201720]] recommend:
	** No routine prophylactic antibiotic in patients with basilar skull fractures and CSF leak		**No routine prophylactic antibiotic in patients with basilar skull fractures and CSF leak
	** Surgical repair if leak lasts more than 7 days		**Surgical repair if leak lasts more than 7 days
	** Pneumococcal vaccination		**Pneumococcal vaccination

	==Further Reading==		==Further Reading==

	* Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. ''Clin Infect Dis''. 2017;64(6):e34-e65. doi: [https://doi.org/10.1093/cid/ciw861 10.1093/cid/ciw861]		*Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. ''Clin Infect Dis''. 2017;64(6):e34-e65. doi: [https://doi.org/10.1093/cid/ciw861 10.1093/cid/ciw861]

	[[Category:CNS infections]]		[[Category:CNS infections]]

Aidan: Created page with "==Background== * CSF leaks are associated with a high risk of meningitis (10-25%, depending on etiology and chronicity) ==Management== * Current IDSA guidelines recommend: **..."

2020-06-16T23:04:32Z

Created page with "==Background== * CSF leaks are associated with a high risk of meningitis (10-25%, depending on etiology and chronicity) ==Management== * Current IDSA guidelines recommend: **..."

New page

==Background==
* CSF leaks are associated with a high risk of meningitis (10-25%, depending on etiology and chronicity)

==Management==
* Current IDSA guidelines recommend:
** No routine prophylactic antibiotic in patients with basilar skull fractures and CSF leak
** Surgical repair if leak lasts more than 7 days
** Pneumococcal vaccination

==Further Reading==
* Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. ''Clin Infect Dis''. 2017;64(6):e34-e65. doi: [https://doi.org/10.1093/cid/ciw861 10.1093/cid/ciw861]

[[Category:CNS infections]]