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Warning-sign checks

CSF leak: when to get help

Go through these in order and stop at the first one that applies. If you are reading this for someone else, answer for them.

  1. 1

    Is any of this happening now?

    Call 911

    Seek emergency care for:

    • Fever with severe headache, stiff neck, light sensitivity, or a new rash
    • Confusion, unusual drowsiness, collapse, or a seizure
    • New weakness, numbness, trouble speaking, or loss of coordination
    • A sudden severe headache unlike your usual symptoms
    • Clear nose or ear drainage after a significant head injury
    • Repeated vomiting or rapidly worsening neurological symptoms
    Other emergency signs, for anyone
    • Someone who is struggling to breathe, gasping, choking, or cannot get words out
    • Someone who has chest pain, tightness or pressure lasting more than a few minutes
    • Someone who has sudden weakness or drooping on one side of the face or body, slurred speech, or sudden confusion
    • Someone who is unconscious, or cannot be woken
    • Someone who is bleeding heavily and it will not stop with firm pressure
    • Someone who has had a seizure that will not stop, or does not wake up afterwards
    • Someone who has lips or skin that look pale, blue, grey or blotchy
    • Someone who you believe has taken an overdose or swallowed something poisonous
  2. 2

    Is any of this happening?

    Be seen today

    Arrange prompt medical assessment for a new headache that is consistently worse upright and better lying flat, especially after a lumbar puncture, spinal injection, operation, or injury.

    These signs may have causes other than a CSF leak but require urgent assessment.

    Contact the team managing the leak sooner if symptoms return after treatment or change from an upright headache to one that is worse lying down.

  3. 3

    Does any of this apply?

    Book an appointment

    Stable positional headaches, tinnitus, or slowly changing symptoms usually need planned clinical review.

The article also says

Clear watery drainage from one side of the nose or an ear also needs assessment, particularly after head trauma or skull, sinus, or ear surgery.

Do not repeatedly sniff or taste the fluid.

If practical, collect a clean sample for testing, but do not delay care to do so.

Every sign above is quoted from the sofidex article on CSF leak. If you are not sure, err upward — it is always reasonable to be checked.