Causes of Spontaneous Cerebrospinal Fluid (CSF) Leaks

Primary Etiologies

• The American College of Radiology identifies the three main causes of spontaneous cerebrospinal fluid leaks as dural defects, leaking meningeal diverticula, and CSF-venous fistulas 1, 2
• Leaking meningeal diverticula are outpouchings of the dura that can rupture or leak CSF, and CSF-venous fistulas are abnormal connections between the CSF space and venous structures 1, 2

Predisposing Conditions and Risk Factors

• Spinal osteophytes can perforate the dura, creating a pathway for CSF leakage, and collagen vascular disease is associated with weakened ectatic dura and meningeal cysts 1, 2
• A history of bariatric surgery may weaken the dura and predispose to CSF leakage due to rapid loss of epidural fat 1, 2
• Idiopathic intracranial hypertension is a condition where many spontaneous CSF leaks are seen in patients 3

Anatomical Considerations

• Most symptomatic CSF leaks occur in the spine rather than intracranially, and pressure dynamics contribute to the predominance of spinal leaks 1, 2

Special Considerations

• Medication-induced CSF leaks can occur in patients with prolactinomas treated with dopamine agonists like cabergoline, causing CSF rhinorrhea 4