Cerebrospinal fluid, or CSF, is a clear, colorless liquid that plays a crucial role in maintaining the health and function of your central nervous system. It cushions the brain and spinal cord, provides nutrients and removes waste products.
Despite its importance, problems related to CSF often go unnoticed until something goes wrong.
I am a neurologist and headache specialist. In my work treating patients with CSF pressure disorders, I have seen these conditions present in many different ways. Here’s what happens when your cerebrospinal fluid stops working:
What is cerebrospinal fluid?
CBF is made of water, proteins, sugar, ions and neurotransmitters. It is primarily produced by a network of cells called the choroid plexus, which is located in the brain’s ventricles, or cavities.
The choroid plexus produces approximately 500 milliliters of CSF daily, but only about 150 milliliters are present within the central nervous system at any given time due to constant absorption and replenishment in the brain. This fluid circulates through the ventricles of the brain, the central canal of the spinal cord and the subarachnoid space surrounding the brain and spinal cord.
Cerebrospinal fluid circulates throughout the brain and spinal cord.
OpenStax, CC BY-SA
CSF has several critical functions. It protects the brain and spinal cord from injury by absorbing shocks. Suspending the brain in this fluid reduces its effective weight and prevents it from being crushed under its own mass. Additionally, CSF helps maintain a stable chemical environment in the central nervous system, facilitating the removal of metabolic waste and the distribution of nutrients and hormones.
When the production, circulation or absorption of cerebrospinal fluid is disrupted, this can lead to significant health issues. Two notable conditions are CSF leaks and idiopathic intracranial hypertension.
CSF leak
A CSF leak occurs when the fluid escapes through a tear or hole in the dura mater – the tough, outermost layer of the meninges that surrounds the brain and spinal cord.
The dura can be damaged from head injuries or punctured during surgical procedures involving the sinuses, brain or spine, such as lumbar puncture, epidurals, spinal anesthesia or myelogram. Spontaneous CSF leaks can also occur without any identifiable cause.
CSF leaks were originally thought to be relatively rare, with an estimated annual incidence of 5 per 100,000 people. However, with increased awareness and advances in imaging, health care providers are discovering more and more leaks. They tend to occur more frequently in middle-aged adults and are more common in women than men.
Risk factors for the condition include connective tissue disorders such as Ehlers-Danlos syndrome as well as postural orthostatic tachycardia syndrome.
