Fluid Leak From the Spinal-Epidural Puncture Site: Is That Cerebrospinal Fluid?

We present the case of a 30-year-old parturient who underwent a combined spinal-epidural for an elective cesarean section and subsequently experienced fluid leakage at the puncture site. The fluid analysis indicated a glucose level of 57 mg/dL, which initially raised suspicion of a cerebrospinal fluid fistula. However, an MRI revealed no significant abnormalities, and the patient remained asymptomatic. We aim to highlight that various fluids can emerge from a neuraxial puncture site, including cerebrospinal fluid, interstitial fluid due to edema, or residual local anesthetic. While glucose measurement has been used for diagnosing cerebrospinal fluid leakage, its reliability is questionable. More dependable diagnostic tests can be used such as the measurement of beta-trace protein or beta-2-transferrin or MRI.