Differential Diagnosis for Spinal Leak

Single Most Likely Diagnosis

• Post-Dural Puncture Headache (PDPH): This is the most likely diagnosis for a spinal leak, as it is a common complication of lumbar punctures or spinal anesthesia. The headache is typically postural, worsening when standing and improving when lying down.

Other Likely Diagnoses

• Spontaneous Intracranial Hypotension (SIH): This condition is characterized by a spontaneous leak of cerebrospinal fluid (CSF) without a clear traumatic cause. It can present with postural headaches similar to PDPH.
• Cerebrospinal Fluid Leak: A direct leak of CSF from the spinal canal can cause symptoms similar to PDPH, including postural headaches and nausea.

Do Not Miss Diagnoses

• Meningitis: Although less likely, meningitis is a potentially life-threatening condition that can present with headache and stiff neck. It is crucial to consider this diagnosis to avoid missing a serious infection.
• Subarachnoid Hemorrhage: A hemorrhage in the space surrounding the brain can cause a sudden, severe headache and is a medical emergency.
• Epidural Abscess: An abscess in the epidural space can cause symptoms similar to a spinal leak, including pain and neurological deficits. Prompt diagnosis and treatment are essential to prevent serious complications.

Rare Diagnoses

• Cerebral Venous Sinus Thrombosis: A blood clot in the venous sinuses of the brain can cause headache and other neurological symptoms. This condition is rare but can be life-threatening if not recognized and treated promptly.
• Pseudomeningocele: A collection of CSF that leaks out of the spinal canal and accumulates in the soft tissues can cause a palpable mass and symptoms similar to a spinal leak. This condition is rare and often associated with trauma or surgery.