Xanthochromia can persist for as long as several weeks after a subarachnoid hemorrhage (SAH). Thus, it has greater diagnostic sensitivity than computed tomography (CT) of the head without contrast, especially if the SAH occurred more than 3-4 days before presentation.

Elevated CSF protein levels may cause yellowish discoloration of the CSF because of the presence of albumin-bound bilirubin; this usually requires a protein concentration in excess of 150 mg/dl. Discoloration may be seen at lower protein concentrations if the patient also has jaundice.

Xanthochromia, from the Greek xanthos (ξανθός) “yellow” and chroma (χρώμα) “colour”, is the yellowish appearance of cerebrospinal fluid that occurs several hours after bleeding into the subarachnoid space caused by certain medical conditions, most commonly subarachnoid hemorrhage.

Color of the fluid—normal is clear and colorless. Changes in the color of the CSF are not diagnostic but may point to additional substances in the fluid. Yellow, orange, or pink CSF may indicate the breakdown of blood cells due to bleeding into the CSF or the presence of bilirubin.

A CSF leak is a serious health issue. It involves this type of fluid escaping through a tear in the dura mater. The symptoms of a CSF leak include fluid drainage from the ears or nose and a headache that worsens when the head is upright.

What are the symptoms of a cerebrospinal fluid leak?

1. Positional headaches, which feel worse when sitting upright and better when lying down; caused by intracranial hypotension.
2. Nausea and vomiting.
3. Neck pain or stiffness.
4. Change in hearing (muffled, ringing in the ears)
5. Sense of imbalance.
6. Photophobia (sensitivity to light)

Untreated CSF leaks can lead to life-threatening meningitis, brain infections, or stroke. UT Southwestern specialists offer rapid, accurate diagnosis of this dangerous condition, world-class surgical services to correct it, and pre- and post-surgical care that optimizes each patient’s treatment and recovery.

In many cases, a CSF leak will heal on its own accord following conservative treatment, including strict bed rest, increased fluid intake and caffeine. Conservative treatment and the tincture of time is not always enough, however.

To determine the exact location of the leak, a CT cisternogram would be performed. A CT cisternogram involves using a contrast injected into the spinal fluid through a spinal tap and then performing CT scans. This test identifies the exact location of the CSF leak and the pathway of the drainage into the nose.

The most common and classic symptom suggestive of a spinal CSF leak is a positional headache: a headache that is worse when upright and improved when positioned horizontally. It is not unusual for the headache to become less positional over time, or for the positional aspect to resolve entirely.

Rhinorrhea (runny nose) that is clear and watery may be the first sign of cerebrospinal fluid rhinorrhea. 1 Other signs and symptoms may include: Headache. Salty or metallic taste in the mouth1

Symptoms of a cerebrospinal fluid (CSF) leak can include: Headache, which feels worse when sitting up or standing and better when laying down; may come on gradually or suddenly. Vision changes (blurred vision, double vision, visual field changes) Hearing changes/ringing in ears.

When the pressure of this fluid is too low typically when there is a small leak somewhere in the meninges — the brain may sag downward when the patient is upright, stretching the meninges and nerves lining the brain and causing pain.

CSF leaks can cause fluid to leak through the ears, through the nose or into the spinal canal. CSF leakage through the ears or nose should be diagnosed and treated quickly and effectively to prevent meningitis, an infection of the meninges.

All patients presented with a postural headache; however, most had additional symptoms, including nausea, emesis, sixth cranial-nerve paresis, or local back pain at the level of the CSF leak.

How do I care for myself while I have a CSF leak?

1. Stay in bed with your head raised on pillows.
2. Do not blow your nose.
3. Avoid coughing.
4. Avoid vomiting.
5. Avoid straining when you have a bowel movement.

Any CSF leak is most often characterized by orthostatic headaches, which worsen when standing, and improve when lying down. Other symptoms can include neck pain or stiffness, nausea, vomiting, dizziness, fatigue, and a metallic taste in the mouth.

Imaging Limitations Imaging of patients with CSF leaks often initially is read as normal, and MRI is not an adequate evaluation in the high clinical suspicion of a leak, Dr. Carroll said. “It is a good place to start, because if you see a leak on your MRI, maybe you do not have to get a CT myelogram,” he said.

There may be apparent downward displacement of the optic chiasm and the upper cervical epidural veins may appear congested. Spinal MRI scans for patients with a suspected CSF leak may show some irregularity of the thecal sac due to partial dural collapse.

Recently however, using radioisotope cisternography, Ishikawa et al, 2007 reported identification of CSF leaks primarily in the lumbar spine at the dural sleeves in 37 of 66 chronic whiplash patients with headache, memory loss, dizziness and neck pain.