The evolution of presenting signs and symptoms of lateral skull base cerebrospinal fluid leaks

Abstract

To review the presenting signs and symptoms of spontaneous cerebrospinal fluid (CSF) leaks of the lateral skull base. Research continues to demonstrate that CSF leaks from the lateral skull base are insidious, and present with subtle signs and symptoms. Patients commonly present with symptoms of aural fullness, middle ear effusion, and otorrhea following tympanostomy tube insertion that can be confused for chronic otitis media. More recently headache, pulsatile tinnitus, and dizziness/vertigo are being recorded as symptoms at presentation, which is likely a reflection of the association of spontaneous CSF leak with obesity, intracranial hypertension, and superior canal dehiscence. The presence of these less common symptoms in the setting of middle ear effusion should raise suspicion for CSF leak. The rate of meningitis in spontaneous CSF leak is not negligible, and patients should be counseled on this life-threatening risk. Spontaneous CSF leak from the lateral skull base presents with subtle signs and symptoms and remains a diagnostic challenge. Less common symptoms may represent associations with underlying comorbidities, and awareness of the increasing coincidence of diseases that accompany spontaneous CSF leak is essential to prompt diagnosis and management.