What's the Difference Between a Runny Nose and a CSF Leak?

A runny nose just might be a runny nose, but a CSF leak could still be a possible cause of your nasal discharge.

Omaha resident Kendra Jackson was told for years that allergies were the cause of her chronically runny nose and severe headaches. But her story made headlines after she finally discovered the real culprit: fluid leaking from the area around her brain.

According to KETV Omaha, doctors at Nebraska Medicine diagnosed Jackson with a cerebrospinal fluid (CSF) leak, which apparently started after a car accident in 2013. Since then, she'd been losing approximately 8 ounces of fluid a day.

Using non-invasive surgical techniques, doctors were able to plug Jackson's leak using her own fatty tissue–and her condition improved. "I don't have to carry around the tissue anymore," Jackson told KETV, "and I'm getting some sleep."

So how worried should the rest of us be when our noses won't stop running? To put things in perspective, Health spoke with Chirag Patel, MD, an ear, nose, and throat doctor at Loyola Medicine. Dr. Patel was not involved in this case but has specialized in CSF leaks and has treated them often. Here, Dr. Patel answered our most pressing questions.

What Exactly Is Cerebrospinal Fluid?

"Cerebrospinal fluid is the clear, watery fluid that surrounds and protects the brain," Dr. Patel said. "It provides some buffering, and it exists at a certain pressure that has to be kept pretty consistent." That pressure is regulated, in part, by the cardiovascular system, as noted by a November 2018 Nature Communication article. It fluctuates with each heartbeat, and it goes up and down with changing blood pressure. If the pressure around the brain becomes too high, that fluid can wear away at the bone that separates the brain and the nose—or the brain and the ear—and cause a hole where fluid can leak out.

How Can You Tell the Difference Between a Runny Nose and a CSF Leak?

A runny nose will usually clear up with the assistance of cold and allergy medications. But when it comes to a CSF leak, it isn't just any runny nose, Dr. Patel said. "Usually with a CSF leak, the dripping is only on one side of the nose—and it drips constantly, like a faucet," Dr. Patel added. "Also, if it has a salty or metallic taste, that's a sign that it could be spinal fluid."

CSF leaks are often mistaken for sinus problems or allergies because a runny nose is one of the most common symptoms. Additionally, the clear nasal discharge from a regular runny nose that, for example, might be due to allergies or being out in colder weather can look very similar to cerebrospinal fluid leakage.

Still, Dr. Patel said, "there are a lot of reasons you might have a runny nose or a clogged ear, and this would usually be lower on the list of possible causes." In other words, you don't have to be concerned about every sign of allergies or a simple cold as a potential symptom of a CSF leak.

What Are Other Signs of CSF Leaks?

Cerebrospinal fluid can also leak from the ear—something that happened to Mark Hoffman, the subject of another news story published in 2017. Hoffman told the Indianapolis Star that he'd wake up every morning with clear fluid on his pillow and that he'd used more than 5,000 cotton balls over the past 10 years to absorb the fluid that dripped all day long.

"If the leak is in the ear, it can cause hearing loss and a sense that the ear is clogged," Dr. Patel said. "When the ear gets examined, the doctor sees fluid behind the ear drum."

How Common Are CSF Leaks—And How Do They Occur?

A spontaneous CSF leak is most common in women of childbearing age, Dr. Patel said, but it can also happen to men and at any age. Overweight individuals are also at increased risk since they tend to have higher blood pressure. Additionally, healthcare providers have noted an increase in CSF leaks due to rising rates of obesity—a connection supported by an October 2017 Laryngoscope Investigative Otolaryngology study.

Research has suggested that spontaneous CSF leaks affect at least five out of every 100,000 people each year, and experts believe that many more people may go undiagnosed or misdiagnosed for long periods of time.

That number doesn't include CSF leaks that are caused by trauma. CSF leaks can occur after a head, brain, or spinal surgery, a spinal tap, or any type of injury to the head, per MedlinePlus. Jackson stated that her runny nose, coughing, and sneezing began "a couple years after a traumatic car accident" in which her face hit the dashboard.

How Dangerous Are CSF Leaks?

CSF leaks aren't immediately life-threatening, but they can cause serious complications. "If you lose enough fluid fast enough, it causes pretty intense headaches," Dr. Patel explained. "But the bigger concern is that your body can't keep up with fluid production, and air enters the space around the brain where the fluid should be."

Air can also be forced into that space when a person blows their nose repeatedly, in an attempt to clear up their runny nose and "allergies," Dr. Patel said. "If there's too much air, it will push the brain around to create space, and that can become life-threatening," Dr. Patel added.

CSF leaks can also become dangerous if part of the brain starts to push through the hole in the bone. "Anytime there's communication between the brain and the outside world, there's a chance you could develop an infection," Dr. Patel explained, adding that about 15% of people with an active CSF leak develop meningitis, a potentially fatal inflammation of the brain.

How Are CSF Leaks Treated?

Some CSF leaks require a CT scan or a spinal tap for diagnosis, but if you're able to collect a sample of the liquid, healthcare providers can also test it for a specific protein that's only present in cerebrospinal fluid.

Once a CSF leak is diagnosed, it can usually be repaired with non-invasive surgery. "In most cases, when there is a nasal leak, we do the surgery entirely through the nose—just like we would do sinus surgery," Dr. Patel said.

If a leak was caused by trauma or surgery, patching the hole is usually sufficient, Dr. Patel added. But if it was a spontaneous leak, meaning it was caused by a buildup of pressure over time, it's important to address the underlying cause so another leak doesn't develop.

"That means there needs to be long-term management of whatever it was that caused that increased pressure," Dr. Patel explained. "That could mean weight loss, diet changes, or medications that can bring down the pressure." Some people need to have shunts implanted to regularly drain cerebrospinal fluid and keep their pressure controlled as well.

If your issues with a runny nose persist, however, or if they're accompanied by other worrisome signs (like severe headaches), be sure to get them checked out by your healthcare provider.

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