Causes

A spinal CSF leak can be caused by a sudden traumatic event or can occur spontaneously. Some predisposing factors linked with a spinal CSF leak include:

1. Connective Tissue Disorders

  • Ehlers-Danlos syndrome type II

  • Joint hypermobility

  • Personal or family history of arterial dissections, aneurysms and nonrheumatic valvular heart disease

  • Underlying unrecognized intracranial hypertension

  • Marfan syndrome

  • Autosomal dominant polycystic kidney disease

    2. Spine Disorders

  • Calcified herniated disks

  • Osteophytes and spondylotic spurs

  • CSF venous fistulas

  • Dural weakness involving nerve root sleeves 

Experts have noted that individuals with connective tissue disorders or spine disorders may have dural weakness which can lead to tears in the dura.

3. Medical Procedures (Iatrogenic)

CSF leaks can also occur secondary to medical procedures or trauma.  These CSF leaks are not considered spontaneous unless caused by trivial trauma or movement.

  • Lumbar punctures, epidural catheter placement and epidural injection

  • Spinal surgery

  • Bariatric surgery

    4. Trauma

  • Motor vehicle accident, whiplash, sports injury

  • Trivial injuries or physical activities

  • Valsalva related: heavy lifting, coughing, straining

  • Repetitive truncal torsion: tennis, golf, yoga, kayaking, canoeing

  • Nerve root sleeve tears or avulsions


    5. Unknown

Key Notes

  • Some experts believe that an underlying unrecognized intracranial hypertension may be a contributing factor for some patients.