Water Dripping From Nose When Bending Over – A Cerebrospinal Fluid (CSF) Leak

Water dripping out of your nose when bending over that has been going on for a long time accompanied by a severe headache could be a Cerebrospinal Fluid (CSF) leak. A CSF leak is watery and mostly colorless to identify and can be caused by a severe head injury or a previous head surgery. After a diagnosis, your doctor can treat it either by a conservative or invasive approach.

You can generally confuse water dripping down from your nose with seasonal allergies or even cold or flu.

You can’t imagine that this fluid could also result from a serious issue that needs checking immediately. It could be a CSF leak that may also be leaking from your ears. It’s combined with a severe headache which seems to subside only when you lay down.

The severity of CSF might depend on your symptoms, and the treatment will take place after proper diagnosis.

But let’s start from the beginning and understand what this fluid is and how it came to leak out from your nose? Then, let’s look at various treatments and how you can get it treated right!

What is Cerebrospinal fluid (CSF) leak?

Cerebrospinal fluid (CSF) is a clear fluid that surrounds your brain and spinal cord. It cushions your brain and spinal cord from injury.

Also, it serves as nutrient delivery and waste removal system for the brain. CSF is manufactured continuously in areas of the brain called ventricles, and the bloodstream absorbs it.

CSF is one reason why your brain doesn’t land with a thud every time you jump around. A membrane keeps the CSF contained like a giant water balloon around your brain and spinal cord.

A CSF leak happens when anything damages the membranes, such as a head injury, surgery, or a tumor, leaving a hole through which this fluid leaks out from your nose and ear.

Symptoms of CSF

A man is touching his head as he's having a severe headache, a symptom of Cerebrospinal Fluid Leak.

As mentioned before, the most common symptom of CSF is severe headache, often misdiagnosed as a migraine.

The headache worsens when you might be in an upright position or while sitting. Still, it usually disappears when you lay down.

Another more prominent symptom is witnessing a water leak through your nose and ears whenever you move your head and especially whenever you bend down.

Initially, people ignore this leak from their nasal passage, thinking they have a cold or sinus. However, you might also feel the liquid drain down your throat, whose taste can be described as salty and metallic.

Other symptoms might include tinnitus, ringing in the ears, hearing loss, and even vision changes.

To be sure if what you have is a CSF leak, pay attention to these:

  • The probability of having a CSF leak increases when you have fluid coming out of your one nasal passage or one ear rather than both. Since when you have a cold or allergies, both nasal passageways will secrete fluid.
  • The fluid leakage has been going on for too long now. More than what you might go through when with a cold. Remember your cold doesn’t last more than ten days, even without medications.
  • Whenever you tilt your head or bend down, you might experience leakage through the nose or ear.
  • You might have suffered a head injury of some sort in the past or some surgery. The drainage might have started due to that.
  • You might be a person with seasonal allergies, and once the season is gone, so is your allergy. A CSF leak surpasses seasons.
  • The fluid leakage is more as compared to when you suffer from a cold or allergy.

Causes of CSF leak

If you suffered from head trauma, fractured bones in the face or the temporal bones on either side of the skull, or had surgery done in the past, you have a higher chance of getting a cerebrospinal fluid (CSF) leak. Up to 90% of all CSF leaks have resulted from head injuries of different sorts.

Other causes of a CSF leak might include:

  • Infection
  • An epidural injection
  • An anesthetic injection
  • A lumbar puncture
  • Brain tumors
  • Structural abnormalities of the skull that have been present from birth

Diagnosing CSF leak

Once you think you have a CSF leak, the next step is getting the correct diagnosis from your doctor for better treatment. Your doctor will do several tests to see what’s going on.

One way to test it is by placing a sample of CSF discharge on a piece of filter paper. Once in contact with the filter paper, any CSF will separate from any blood or mucus. The result will form two distinct rings, called a “target” or “double ring” sign.

Your doctor will be able to tell apart CSF just by looking at a sample on a handkerchief or a piece of gauze. The mucus you get is thick and sticky when touched, but CSF is clear and watery.

When compared with mucus to identify CSF has a high concentration of glucose. So, the glucose level test can determine if it’s a CSF leak.

If your doctor suspects a CSF leak, they will further do an MRI scan or a CT scan to confirm the diagnosis.

Treating CSF leak

Depending on the severity of your CSF, there are two treatment options.

Conservative treatment

Conservative treatments focus on managing your CSF symptoms. These treatments may include:

  • Bed rest
  • Staying hydrated
  • Taking over the counter or prescription pain relief medication
  • Receiving intravenous caffeine infusions

Endoscopic repair of CSF leak (drainage from nose)

Another way of treating a CSF leak is through the endoscopic repair process. In this treatment, the leak is accessed through the nasal passage of the patient. No external incision is required in this process.

Your doctor will locate the leak and place small pieces of tissue from the nasal lining on the site. The success rate of treating CSF leak through nasal passage is 90-95 percent and is far less risky than other treatments.

Endoscopic repair needs to be done carefully, or even this procedure can have certain risks:

  • bleeding, scarring, or infection
  • change in smell or taste
  • injury to the eye
  • infection spreading to the brain, resulting in meningitis

Your recovery will differ depending on the severity of the leak and the type of approach used to treat the CSF leak. People with conservative treatment can expect to stay in bed for at least three days, with their heads elevated at all times.

Invasive treatments

If the CSF leak doesn’t respond to the conservative treatment, your physician should look at a more invasive approach.

Epidural blood patch

An epidural blood patch is one of the approaches where a surgical procedure involves using a person’s own blood to patch tears in the dura mater. The surgeon draws 5-25 milliliters of the person’s blood then injects it into a space just outside of the tear in the dura mater.

Epidural blood patches have high success rates but may not cure all types of CSF leaks. An EBP can be directed (placed right where there is a fluid leak) or non-directed (placed at the lumbar or thoracolumbar locations).

How EBP is helpful remains a bit of concern since patching remotely from actual leak locations is often helpful. Usually, a non-directed EBP is performed when the leak site has not been confirmed or for diagnostic purposes. It’s a good diagnosis, but it might lack durability. 

For people who go through EBP, your doctor will advise you to take precautions like avoiding bending, lifting, twisting, and straining for about 4 to 6 weeks.

Epidural patch with fibrin glue sealant

Fibrin glue sealant is a biologic adhesive comprised of a pool blood product that has been treated with a two-step process to reduce the risk of viral transmission. This glue is pre-treated with medication to reduce risk otherwise can result in allergic or anaphylactic reactions. 

This glue is injected into the epidural space and is considered an offbeat treatment but works well under a physician with years of practice and experience. Neuroradiologists mostly perform this procedure with imaging guidance and intravenous sedation to target specific known or suspected leak locations.

Surgery

Surgery is another option that your doctor might recommend if:

  • A CSF leak that doesn’t improve with conservative treatment
  • A severe CSF leak that doesn’t heal on its own
  • Blood clotting in the brain or spinal cord
  • Herniated brain tissue that pushes into the ears or nose
  • Meningitis

During the surgery, stitches will be used to prevent further CSF leakage.

During the surgery, stitches are done to prevent further CSF leakage. This approach depends a lot of the location of the tear. For example, if the tear is in dura mater at the front of the head and causes the fluid to leak through the nose, the neurosurgeon may perform an endoscopic repair.

This procedure involves inserting a thin, flexible tube called an endoscope through the nose. Through the tube tiny surgical tools are passed to repair the tear. If the fluid leak is from your ears then your neurosurgeon will need to perform open surgery.

You can expect to stay in the hospital for a few weeks or days for a surgical repair. You’ll be monitored closely by healthcare providers to see if any complications are there.

Precautions after CSF leak repair

After getting the required treatment which depends on the severity of your CSF leak your doctor will give you a set of instructions to follow in order to recover quickly. You should follow these for the next 4 to 6 weeks after your CSF leak repair.

  • avoiding lifting anything heavy
  • avoiding bending, stretching, and twisting
  • avoiding straining to have bowel movements
  • avoiding coughing it sneezing, although it can’t be avoided so you must keep your mouth open while doing it
  • don’t blow your nose
  • don’t use straws
  • keep your posture straight and only bend on knees and hips

FAQs

How do you know if your brain fluid is leaking from your nose?

Clear and watery fluid from one side of your nose or one ear when you bend over. Salty metallic taste in your throat or mouth. Drainage down the throat. Loss of smell.

Why does my nose keep dripping water?

There could be various reasons for getting dripping water out of your nose. Some of the common causes include allergies and infections like cold and flu. Other factors could also make a runny nose possible, like the kind of food you eat, medications, or changes in hormones.

If there’s constant dripping water from your nose, you might have a CSF leak which you should get checked with your doctor.

Is a CSF leak serious?

CSF leak can occur due to a previous head injury or a surgery that might create a hole in your membranes and cause the leak. It’s a severe condition that needs to look into quickly if you’ve been witnessing nasal drainage for some time now. These need to be repaired to prevent meningitis.

What color is brain fluid?

The color of brain fluid is clear and colorless. It’s different from mucus because mucus is slightly yellow with thick and sticky consistency, but brain fluid is watery.

There might be changes in brain fluid color if things are serious. For example, yellow, orange, or pink might indicate the breakdown of blood cells due to bleeding into the CSF or the presence of bilirubin.

To summarize

For a long time, if you have noticed water dripping from your nasal passage or one ear, especially when bending over, that could be a CSF leak.

Another noticeable symptom is a severe headache which might be confused with a migraine in the beginning.

If you suspect a CSF leak, you can get yourself diagnosed by your doctor, who will perform specific tests to see if you have a CSF leak. There are different ways that your doctor can treat a CSF leak after the diagnosis.

Don’t take your nose drainage lightly, and pay attention to your symptoms. If you suspect a CSF leak, it’s better to visit your doctor to get the proper treatment within the right time.