Cerebrospinal Fluid CSF Leaks Symptoms Houston - CSF Leak Causes
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Cerebrospinal fluid (CSF) is a clear mixture of water and electrolytes circulating around the brain and spinal cord. A disruption in the brain lining, or in the bone separating the brain from the sinuses, may result in the drainage of cerebrospinal fluid into the nose. Many times the drainage will appear as a noticeable clear nasal drip when leaning or bending over. A CSF leak is a very dangerous potentially life-threatening condition because it can lead to meningitis which is an infection of the cerebrospinal fluid and the lining covering the brain. For such serious problems you need to see a nose and sinus specialist at Houston Advanced Nose & Sinus. Dr. Kuperan is one of the few fellowship certified Rhinologists in all of Texas with specialized expertise, experience, and skills in treating patients with all types of cerebrospinal fluid leaks.


CSF is primarily produced in the choroid plexus (an area within the brain) and is continuously replenished. A CSF leak results from several different causes. Some patients have unexplained elevated intracranial pressure which over time causes the bone between the brain and sinuses to remodel and become thinner ultimately leading to a CSF leak. Other patients get a CSF leak from hitting their head or face during a traumatic accident which causes a fracture of the thin bone separating the brain from the sinuses. In rare cases, patients getting sinus surgery can suffer a CSF leak if an inexperienced surgeon has accidentally penetrated through the thin sinus bones while operating. Concerning symptoms associated with a CSF leak include:

  • Severe headaches in the upright position, which alleviate while lying down.
  • Clear watery nasal drainage from only one side of the nose that is worse when getting up from a seated or lying down position

  • Watery postnasal drip that has a salty taste
  • New onset neck stiffness


If you have signs or symptoms of a CSF leak it is critical to consult a Rhinologist immediately for an accurate diagnosis and treatment plan. The fluid that drains from the nose can be collected and tested to see if it contains beta-2 transferrin, a protein very unique to CSF. A CT scan (x-ray) of your sinuses and nasal endoscopy (looking inside the nose with a small camera) is essential to better assess the problem. The nasal endoscopy can show where specifically the leak is coming from and the CT scan can visualize any fractures of the bone between the brain and the sinuses. If there is a small leak a lumbar spinal drain can be placed to decrease the intracranial pressure and see if the CSF leak spontaneously resolves. A persistent CSF leak after lumbar drain placement may require surgery to correct. Since the fluid leaking is clear it may be difficult to differentiate from ordinary mucous produced in the nose. In these cases, a dye called fluorescein can be injected into the CSF space through a lumbar spinal drain that turns the clear fluid into a yellow/green color. This technique localizes the CSF leak very efficiently. Once the source of the CSF leak is identified, the defect can be closed by performing a very technically specialized procedure called a cerebrospinal fluid (CSF) leak repair. The key is choosing an approach tailored to the severity and cause(s) of your CSF leak. There is not one single solution that is correct for every patient, and that’s why Houston Advanced Nose & Sinus is unique. We don’t promote a “cookie-cutter” approach to treatment like some other practices. Dr. Kuperan’s super specialized expertise and experience as a Rhinologist will make sure you get the best treatment to quickly resolve your CSF leak.