Brain Science :
We have said that both the brain and central nervous system have white matter. In the case of the spine, white matter is on the outside of spine and therefore more subject to injury. White matter, as we know, is the connective tissue of the spine. It carries signals up and down the spine to the brain. It is the critical element of the central nervous system. White matter is protected by cerebrospinal fluid. This protective cushion circulates in the nervous system in the space around the brain and spinal cord. In some ways it acts as the shock absorber for the brain and spine.
Both your brain and spine can develop what is called a cerebrospinal fluid leak. Symptoms of spinal leak are: positional headaches, vomiting,change in hearing, imbalance,pain between shoulders. Brain leaks symptoms are: heavy drainage, salty or metallic taste, drainage from ear, ringing in ears, loss of smell. Leaks in the brain can result in cognitive issues, dementia mimicking, swift mood changes,anxiety and imbalance. Spinal leakages can affect the content and number of white cells. A really recent study directly linked spinal fluid leaks to white cell loss and white cell lesions.Obviously, loss of white matter and lesions in white matter can be very damaging if progressive leaks continue. This can lead to serious complications related to cognition, fluid movement and balance. One of the more serious complications is meningitis or ,if not related to injury, MS.
Blunt trauma, not penetrating injuries, are more common causes of leaks.However, penetrating injuries are associated with higher rates of leaks and more complications like meningitis and higher mortality figures.Non traumatic cause of leakes relate to the thinning of bone at base of skull. This leads to further complications. One such complication is idiopathic intracranial hypertension. (The explanation of these types of disorders is beyond the scope of the blog.) This condition more commonly occurs in young to middle aged obese women.
Brain Facts:
Meningitis is the most common complication associated with a leak and is seen in 25 to 30% of patients.
leaks caused by penetrating injuries are more likely to lead to meningitis.
Infections are more likely to occur from penetrating injuries that create leaks.
Many leaks , especially traumatic causes, resolve on their own.
With regard to patients in which the condition is not resolved on it's own, 90% are resolved with surgical repair.
The longer the condition exists the more likely the patient is to get meningitis. 50 to 60% with delayed onset get meningitis
A CSF leak may sometimes point towards an underlying condition like skull base fractures and tumors which cause increased brain pressure.
Non-traumatic causes primarily occur in adults more than 30 years of age and are rare in children less than two.
So What :
Since Most leaks repair spontaneously it is advisable to wait and watch for a short time. Head and back injuries should trigger a watch for symptomes. Should symptoms occur try physical therapy. If they continue, drugs are the next step. Cerebral decongestants have been effective. Your doctor will know what these are.Surgery is used in cases where the condition exists beyond drugs. Obviously, surgical intervention is costly and has side effects. Surgery in some cases results in stents and bypasses.
There is an issue in identifying the leak problem. My last back surgery revealed a tear in the spine. Neither the surgeon nor I noticed the tear until it was discovered in surgery. Many of the symptoms are likely to be ignored, such a clear watery discharge from nose and headaches. The key concept here though, is length of time between the onset of symptoms and treatment. Attention to persistent symptoms is the key. re-acting Too soon risks intervention complications and too late meningitis.
I am thinking here about just how many people have had leaking brains and leaking spines and did not know it. It is Apparently, overlooked quite often. That may not be all bad because the body does heal itself in a lot of cases. In this case what you don't know sometimes doesn't hurt you. I think I would rather know.
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