Diagnosis of CSF<unk> age can be done by various imaging techniques, chemical tests of bodily fluid discharged from a head orifice, or clinical examination. The use of CT, MRI, and assays are the most common types of CSF<unk>  instrumental tests. Many CSF<unk> s do not show up on imaging and chemical assays, thus such diagnostic tools are not definitive to rule out CSF<unk> s. 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. A clinical exam is often used as a means to diagnose CSF<unk> s. 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<unk>  is the greatest challenge to proper diagnosis and treatment, in particular: the loss of the orthostatic characteristic of headache and that every chronic CSF<unk> er will have a unique symptom set that as a whole contributes to the underlying condition, and diagnosis of, a CSF<unk> . 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, Chiari malformation, and psychiatric disorders. The average time from onset of symptoms until definitive diagnosis is 13 months. A 2007 study found a 0% success rate for proper diagnosis in the emergency department. CT Diagnosis of a<unk>  is performed through a combination of measurement of the CSF pressure and a computed tomography myelogram (CTM) scan of the spinal column for fluid<unk> s. The opening fluid pressure in the spinal canal is obtained by performing a lumbar puncture, also known as a spinal tap. Once the pressure is measured, a radiocontrast agent is injected into the spinal fluid. The contrast then diffuses out through the dura sac before<unk> ing through dural holes. This allows for a CTM with fluoroscopy to locate and image any sites of dura rupture via contrast seen outside the dura sac in the imagery. MRI There is disagreement over whether MRI should be the diagnostic tool of choice. Magnetic resonance imaging is less effective than CT at directly imaging sites of CSF<unk> . MRI studies may show pachymeningeal enhancement (when the dura mater looks thick and inflamed), sagging of the brain, pituitary enlargement, subdural hygromas, engorgement of cerebral venous sinuses, and other abnormalities. For 20% of patients, MRIs present as completely normal. MRIs performed with the patient seated upright (vs. laying supine) are not better for diagnosing CSF<unk> s, but are more than twice as effective at diagnosing cerebellar tonsillar ectopia, also known as Chiari malformation. Cerebellar tonsillar ectopia shares many of the same symptoms as CSF<unk> , but originates either congenitally or from trauma, including whiplash strain to the dura. An alternate method of locating the site of a CSF<unk>  is to use heavily T2-weighted MR myelography. This has been effective in identifying the sites of a CSF<unk>  without the need for a CT scan, lumbar puncture, and contrast and at locating fluid collections such as CSF pooling. Another highly successful method of locating a CSF<unk>  is intrathecal contrast and MR Myelography. Contrast-enhanced brain MRI with sagittal reformats can assess for the following: * Subdural fluid collections * Enhancement of the meninges * Engorgement of venous structures * Pituitary swelling * Sagging of the brain For suspected spinal CSF<unk> s, spine imaging can be used to guide treatment. Assay Fluid dripping from the nose (CSF rhinorrhoea) or ears (CSF otorrhea) should be collected and tested for the protein Beta-2 transferrin which would be highly accurate in identifying CS fluid and diagnosing a cranial CSF<unk> . CSF analysis Spinal needles used in lumbar puncture and introduction of contrast into the spine Patients with CSF<unk> s have been noted to have very low or even negative opening pressures during lumbar puncture. However, patients with confirmed CSF<unk> s may also demonstrate completely normal opening pressures. In 18–46% of cases, the CSF pressure is measured within the normal range. Analysis of spinal fluid may demonstrate lymphocytic pleocytosis and elevated protein content or xanthochromia. This is hypothesized to be due to increased permeability of dilated meningeal blood vessels and a decrease of CSF flow in the lumbar subarachnoid space. Myelography A myelogram can be used to more precisely identify the location of a CSF<unk>  by injecting a dye to further enhance the imaging. However, CSF<unk> s are frequently not visible on imaging. For patients with recalcitrant spontaneous intracranial hypotension and no<unk>  found on conventional spinal imaging, digital subtraction myelography, CT myelography and dynamic myelography (a modified conventional myelography technique) should be considered to rule out a CSF-venous fistula. In addition, presence of a hyperdense paraspinal vein should be investigated in imaging as it is highly suggestive of a CSF venous fistula.
Cerebrospinal fluid leak
Pneumocephalus
Brain herniation
Hemicrania continua
Hydrocephalus
Cerebrospinal fluid rhinorrhoea
Intraventricular hemorrhage
Epidural hematoma