Do Fluoroquinolones Cause Cerebrospinal Fluid Leaks?

It is well known that fluoroquinolone antibiotics (Cipro/ciprofloxacin, Levaquin/levofloxacin, Avelox/moxifloxacin, Floxin/ofloxacin, and a few others) damage connective tissues–including musculoskeletal connective tissues like tendons, cartilage, bone, and muscle, as well as other connective tissues such as ocular tissue (including the retina), eardrums, and cardiac/heart tissue. Multiple studies have found that fluoroquinolones are toxic and damaging to connective tissues. Given the wide differences in tissues that fluoroquinolones have been shown to deleteriously affect–from cartilage to cardiac/heart tissue–it is reasonable to assert that they damage all connective tissues throughout the body. (Read any of the articles in the citations listed below for information about how fluoroquinolones damage connective tissues.)

Given that fluoroquinolones damage connective tissues (probably all connective tissues), I have a new, developing, hypothesis for how fluoroquinolones lead to fluoroquinolone toxicity syndrome/fluoroquinolone associated disability (FQAD). Please keep in mind that this is one of many hypotheses, and it is just one among about a dozen possibilities (you can read about some of the other possibilities on the post What is Fluoroquinolone Toxicity, or through the free ebook Hacking Fluoroquinolones.)


Fluoroquinolones damage the dura (dura mater)–the layer of connective tissue that surrounds the brain and spinal cord and keeps spinal fluid around those vital organs. This leads to spinal fluid leakage, which leads to many symptoms of fluoroquinolone toxicity, including:

  • Headaches (Including chronic migraines)
  • Autonomic nervous system dysfunction including POTS (postural orthostatic tachycardia syndrome) symptoms
  • Nausea and/or vomiting
  • Ringing in the ears (tinnitus) and hearing changes
  • Neck pain and stiffness
  • Radicular pain
  • Memory and cognitive problems (and other “neurolgic weirdness”)
  • Fatigue
  • Tachycardia (Racing heart/heart palpitations)
  • Dizziness (especially upon standing)

This wonderful lecture by Dr. Ian Carroll describes how cerebrospinal fluid leaks can lead to symptoms of many illnesses, including “mysterious” diseases like POTS, ME/CFS, fibromyalgia, as well as heart palpitations and severe headaches.

I suggest that you watch the entire video, as well as Dr. Carroll’s other videos on youtube. Here are some notes/highlights from the video above:

  • Many symptoms of POTS are actually cerebrospinal fluid leaks
  • The spinal cord is surrounded by tissue called the dura, and the dura holds cerebrospinal fluid around the spinal cord and brain. It’s like a water-tight bag that holds in cerebrospinal fluid and maintains pressure.
  • What causes people to have cerebrospinal fluid leaks?
    • Messed up connective tissue
      • From connective tissue disorders like ehlers danlos syndrome
      • (From fluoroquinolones???)
    • Something calcified and boney sticking into the dura
      • Bulging discs
    • Iatrogenic damage
      • Lumbar punctures
      • Epidurals
      • Back surgery
    • Car accidents (and other types of jarring, high-speed accidents)
      • Whiplash
  • How do you know if you have messed up connective tissue?
  • Calcium spikes sticking into the dura are difficult to detect via MRI, but they are clearer with a ct myelogram.
  • “Neurologic weirdness” is a sign of cerebrospinal fluid leaks. If someone is more confused later in the day, that can be an example of neurologic weirdness that results from a leak.
  • Cerebrospinal fluid leaks are misunderstood and under-recognized.
    • Post-puncture cerebrospinal fluid leaks are recognized.
    • Longer term cerebrospinal fluid leaks are less recognized and they present differently.
  • Post Dural Puncture Headache (PDPH) vs. Spontaneous Leak
    • Post Dural Puncture Headache (PDPH)
      • Single leak, orthostatic headache, 90% response to single EBP, Natural history understood and mostly benign, rarely mysterious, young women most at risk, fixable.
    • Spontaneous Leak
      • 30-40% multisite leak, late day headache, exertional headache, non-orthostatic CDH, 30% response to single EBP, natural history poorly understood and marked by chronic disability, often mysterious, HDCT, fixable.
  • There are people out there who have cerebrospinal fluid leaks that aren’t being recognized. Many people with cerebrospinal fluid leaks are misdiagnosed. Cerebrospinal fluid leaks are fixable and it is a shame that they aren’t all being recognized.
    • Cerebrospinal fluid leaks are NOT RARE.
  • Symptoms of cerebrospinal fluid leaks:
    • Headache, nausea and/or vomiting, ringing in the ears and hearing changes, neck pain and stiffness, radicular pain, neurological weirdness, fatigue
  • The effects of cerebrospinal fluid leaks on the pituitary gland
    • The pituitary gland is enlarged (How does this affect hormones???)
    • The connection between the pituitary gland and the brain can be disturbed, and this can lead to hormonal disruptions. High prolactin is an indicator of this problem.
  • Cerebrospinal fluid leaks can cause sagging of other parts of the brain.
  • MRIs of people suffering from cerebrospinal fluid leaks often appear normal. They are subtle and most doctors aren’t trained to see them.
  • Treatment of cerebrospinal fluid leaks
    • Epidural blood patches (Dr. Carroll describes how they’re done)
  • Cerebrospinal fluid leaks are NOT RARE, they’re just misdiagnosed and under-recognized

Before I watched Dr. Carroll’s lecture, I knew that cerebrospinal fluid leaks were painful and debilitating, but I didn’t realize that they were connected to “mysterious” disease symptoms or autonomic nervous system damage.

Connecting cerebrospinal fluid leaks to fatigue, a racing heart, blood pressure and blood sugar irregularities, tinnitus, cognitive and memory problems, hormonal abnormalities, etc. establishes a plausible connection between the (well-established) connective tissue damage done by fluoroquinolones, and the array of chronic, mysterious, disease symptoms that people with fluoroquinolone toxicity suffer from. Perhaps fluoroquinolones cause an array of debilitating chronic, mysterious illness symptoms through damaging the dura and allowing cerebrospinal fluid to leak–which leads to multiple symptoms of fluoroquinolone toxicity (and other chronic illnesses). It certainly seems like a plausible hypothesis to me. It actually seems like an easier hypothesis to postulate and prove than many of the other hypotheses regarding fluoroquinolone toxicity that have been put forth. As I noted above, the damage that fluoroquinolones do to connective tissues is well-established and recognized, and if someone looked at the effects of fluoroquinolones on dura mater tissue specifically, this hypothesis would be easily testable.

Some additional evidence supporting the possible connection between fluoroquinolones and cerebrospinal fluid leaks comes from the large number of people in cerebrospinal fluid leak support groups that have taken fluoroquinolones in the past who assert that fluoroquinolones contributed to their cerebrospinal fluid leak. I know that asking people in facebook support groups doesn’t count as a scientific study, but (to the best of my knowledge) no scientific studies of the link between fluoroquinolone use and cerebrospinal fluid leaks has been done, and the testimonials of the people who have cerebrospinal fluid leaks are important–they point both researchers and fellow patients toward research that may provide answers.

I also find it to be interesting that cerebrospinal fluid leaks affect the pituitary gland, which affects hormone production and regulation. Many people with fluoroquinolone toxicity syndrome have hormonal problems–from tanked testosterone to thyroid abnormalities. Maybe fluoroquinolones cause damaged dura tissue, which causes cerebrospinal fluid leaks, which causes pituitary gland structural abnormalities, which causes hormonal dysregulation, which causes multi-symptom chronic illness symptoms.

Dr. Carroll’s hypotheses and observations are fascinating and exciting for those who are dealing with fluoroquinolone toxicity and other multi-symptom, chronic, mysterious illnesses. I hope that they are explored further. Dr. Carroll’s results with patients are incredibly promising, exciting, and hopeful for people who are suffering from multi-symptom, chronic, mysterious illnesses–including those suffering from fluoroquinolone toxicity. I hope that Dr. Carroll, or other clinicians or researchers, look into the connections between fluoroquinolones and chronic cerebrospinal fluid leaks. It’s possible that the connections could lead to a comprehensive theory of fluoroquinolone toxicity, and may also lead to breakthroughs in other chronic illnesses.


Musculoskeletal Complications of Fluoroquinolones: Guidelines and Precautions for Usage in the Athletic Population. Hall, Mederic M. et al. PM&R , Volume 3 , Issue 2 , 132 – 142

Etminan M, Forooghian F, Brophy JM, Bird ST, Maberley D. Oral Fluoroquinolones and the Risk of Retinal Detachment. JAMA. 2012;307(13):1414-1419. doi:10.1001/jama.2012.383

Lee C, Lee MG, Chen Y, Lee S, Chen Y, Chen S, Chang S. Risk of Aortic Dissection and Aortic Aneurysm in Patients Taking Oral Fluoroquinolone. JAMA Intern Med. 2015;175(11):1839-1847. doi:10.1001/jamainternmed.2015.5389

Adel Alrwisan, Patrick J. Antonelli, Almut G. Winterstein; Quinolone Ear Drops After Tympanostomy Tubes and the Risk of Eardrum Perforation: A Retrospective Cohort Study. Clin Infect Dis 2017; 64 (8): 1052-1058. doi: 10.1093/cid/cix032


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19 thoughts on “Do Fluoroquinolones Cause Cerebrospinal Fluid Leaks?

  1. Robert L Paddock May 9, 2017 at 6:31 am Reply

    Thank You Lisa.

    As you know CSF Leaks can also be deadly. The pain form that and the poisoning by Levaquin caused my wife Karen to take her own life to stop the pain. 😦

    • Lisa May 9, 2017 at 7:08 am Reply

      Thank you so much for all your advocacy work, Bob! These connections are because of you and your work – you are appreciated! I’m so sorry for the loss of Karen, and for the suffering that she endured. 😦

  2. Robert L Paddock May 9, 2017 at 6:32 am Reply

    The Karen Paddock story about CSF Leaks and Levaquin on Pain Nation with Ken McKim:

  3. KLS May 9, 2017 at 7:58 am Reply

    Thank you for this interesting topic – scary for sure. I have recently started having intense pain in the bottom of my spine, lower than the tailbone. Have seen a chiro, but he doesn’t know what it could be. I have had x-rays, but not an MRI yet. It just came out of nowhere and sitting has become next to impossible. How do you know if there is a leak? How is this tested for?

    • Lisa May 9, 2017 at 3:31 pm Reply

      Hi KLS,

      I’m so sorry to hear about the pain you’re experiencing! For testing for a leak, you’d have to see a doctor who specializes in it. From Dr. Carroll’s video, it sounds like most doctors struggle with properly identifying leaks.

      Depending on how far down your pain is, it may be pelvic floor muscle dysfunction too. My pelvic floor muscles went haywire about 2 years ago and I experienced some of the worst pain of my life from it. Pain management, time, and stress reduction were the things that helped me. Muscle relaxers may help too. If it is pelvic pain, there is a great book that I recommend called A Headache in the Pelvis. It’s really fascinating.


    • Robert Paddock May 9, 2017 at 6:32 pm Reply

      There are two types of CSF Leaks. Spinal and Cranial.

      The symptoms for Spinal are a position related headache. Typical the pain goes away when laying down and returns when up right. The time varies on the volume of the leak etc. The time can range from seconds to hours. This is some times known as the Afternoon Migraine. There is no 100% reliable test. It can often, yet not as often as one wold like, be seen in CT Melograms. The experts at this are at Duke, Stanford and Cedars Sinai .

      Symptoms for Cranial are clear fluid from the eyes/ears/nose. Often mistaken for a sinus problem for which Cipro etc is given. 😦 This fluid can be detected with a Beta-2-Transferrin lab test. Headache is not a common symptom.

      More details about FQs such as the FDA warnings/hearings and CSF Leaks can be found on Karen’s web site:

  4. Aviatrix79 May 9, 2017 at 3:54 pm Reply

    The meninges are made of collagen, so I don’t see how FQs wouldn’t affect them as well.

  5. Alan B'Stard February 13, 2018 at 8:10 pm Reply

    For better readability, explicating an abbreviation like EBP would be good.

    Re: “pituitary gland is enlarged (How does this affect hormones???)”+”High prolactin is an indicator of this problem.” — prolactin is a pituitary hormone.

    And I wouldn’t write doen the myriad of varying symptoms to just one mechanism. Fluoroquinolones can cause widespread destruction on various levels. But CSF leaks may well be behind some of the issues.

    I wish diagnostics was easier.

  6. Gail April 18, 2018 at 7:10 am Reply

    Can Dr. Carol recommended any physician in Denver Colorado for someone who is experiencing the symptoms and the neurosurgeon will not research whether this is a spinal cord leak

    • Bob Paddock April 18, 2018 at 7:57 am Reply

      Contact Dr Kerry Knievel in Colorado. She has training in CSF Leaks.

    • Bob Paddock April 18, 2018 at 7:57 am Reply

      Contact Dr Kerry Knievel in Colorado. She has training in CSF Leaks.

      • Michael February 15, 2019 at 11:28 pm Reply

        Looks like Dr. Knievel works out of AZ now. Anyone else in Colorado?

  7. Jaci April 19, 2018 at 10:53 am Reply

    Listening to Bob’s story has made me think about initial oddities I experienced early on. Like the short term memory. At work people would tell me something and I’d nod ok, but then I knew they said something, but I would have to go back and ask them what they told me. My co-workers just said I was dreamy acting. A year later I did start to recognize possible absent seizure (EEG said possible but did not catch). I never connected symptoms to FQs until the final time I took it in 2016. Tracing back through medical and prescription records I connected cipro & levequin 3x in 2012 for UTI/kidney infections with suicidal thoughts weeks after dosing. And again in 2014 with severe depression afterwards, until the final time in 2016 when the reaction was immediate within first three pills.

    I am tall. Was flexible as a child (as is my son, more so then me). A random MRI w/o contrast shows possible leak site. I’m near Stanford, but Dr Carroll is no longer accepting patients and recommended going to Santa Barbara which I can’t do right now. I’m not very active or strong, but I will notice when I do over do everyday activities like organizing boxes in garage, lifting and such, my lower back will ache and a week or so afterwards, clear fluid running back down my throat causing coughing, fluid sounds/ringing in my ear. And headaches upon waking in the morning while laying down. As a child I had constant headaches that were resolved after throwing up and laying down. As I got older (high school) they became less. Now only while laying flat on my back in bed (which I avoid doing).

    My thoughts are this is long standing chronic issue for me. Maybe not much is known or can be done. …?

  8. Peggy July 9, 2018 at 12:41 am Reply

    Jaci, do you know why Dr. Carroll isn’t taking patients ? I was just about to contact him regarding my leak. I’m bummed to hear this.

  9. R. George August 7, 2018 at 8:46 pm Reply

    I had a “Spontaneous” CSF leak fixed in 2001 by Craniotomy at U of M- Ann Arbor, MI hospital. It was over a seven hour surgery. Took them over two years for an ENT to finally test the liquid coming out of my ear by the teaspoon full and it was at my insistence they finally tested it! My main symptom was a plugged ear and migraines. I’d had migraines on and off since high school in the early 80’s though, so I didn’t link those with the Cipro. My primary Dr. had given me samples from his closet for years and I’m positive that I’d had Cipro at least a couple of times, but he has since retired and I don’t know how to get my records to prove this. I do have proof of having received Levaquin and Levafloxacin around 5-6 years ago. I made this connection a few years ago, when I saw my exact issue on an episode of Medical Mysteries on TLC. I knew then that this CSF leak was caused/related to something else, then I came upon the Fluoroquinolone Toxicity chat group after talking to another woman about how many medical issue I had for my age. So many that were off the wall abnormal and all diagnosed by my Dr.s. I have/had 22 medical issues including the CSF leak, then Type II Diabetes/High blood pressure diagnosed shortly after & both in the same Dr. visit. Then most recently CLL/SLL Cancer, Myositis, Vasculitis, Gout in one toe after a slight injury, enlarged liver & spleen, even after Chemo Therapy and most recently tendons in my hands that won’t let my fingers close completely.

  10. sraviiitk May 28, 2019 at 10:27 am Reply

    I want to talk to you. I had taken Cipro 250mg for 60 days from Jan 2015 to March 2015. I have been living with all the symptoms that you had mentioned. And I suspect my CSF fluid is also leaking. On Dec 2018, I had a strange pain in my eye. Which got cured by itself in 3-4 weeks. But after this some thick stinky green fluid had started coming from ear. When I went to doctor, he said that ear has a infection and eardrum has a hole. And he said that eardrum hole has been there since birth. But now I suspect that it is due to CSF fluid leak which has burst my ear drum. Now I sense ear ringing and noise all the time. Probably this is Tinnitus.

    Please contact me soon. I don’t my body to deteriorate further.

    • Rhonda May 28, 2019 at 10:59 am Reply

      My CSF leak was actually clear fluid, but made a halo on a handkerchief and felt like satin. They kept putting tubes into my ear for supposed “ear infections”, three in total. My symptoms initially, post actual ear infection, were just a plugged ear and migraines. Everything was muffled and yes I had Tinnitus and still do on occasion. When it gets intense, I do the finger thumping on the lower back of my skull and it calms it. I had to have a specialized CT myelogram type of test to trace the path of my leak, with contrast and without. Should have took the Volume they offered me, it was intense when they tipped me forward to make the dye go faster into my system. The doctors in my town were idiots for almost three years and even after that test they couldn’t read it correctly (Neurologist with a PHD!). I then insisted on going to U of M for their awesome specialists. They saw the path in 30 sec and on the light box backwards! The Dr. with the PHD was trying to cure the hole in my bone, and the drug he used I was allergic to. The hole was the size of a nickel and a small sized portion of my brain fell into the hole and died and was removed. When in doubt keep searching for someone with answers, don’t wait around for them to make stuff up. I now know Cipro did this to me, they have many links to it.

  11. […] In a couple posts on this site, I have noted that ME/CFS caused by connective tissue disorders may be proceeded (even caused by) fluoroquinolone exposure. You can read about these theories in the posts Are Fluoroquinolones Causing Connective Tissue Disorders that are Leading to ME/CFS? and Do Fluoroquinolones Cause Cerebrospinal Fluid Leaks? […]

  12. Michael December 16, 2019 at 6:42 am Reply

    I was screened for a leak as I had all the mentioned symptoms and more. Have even communicated with Dr Carroll a few times. He is great to deal with. I had MRI’s and a lot of testing and it was all inconclusive however after a lumber puncture found out I did not have a leak, but rather had Intracranial Hypertension (excess CSF pressure). The opening pressure was 23.5 whereas it should be 15-18 in a normal person. If over 25 they give you Diamox to lower it and protect your optic nerves. A tarlov cyst was also found on my MRI scan in my thoracic spine so yes there is suspicion of connective tissue situation.

    The excessive pressure it likely due to CNS inflammation and I have been working on getting heavy metals out of my body and trying to detox (Had a mouth full of amalgam). Have had chronic symptoms now for nearly 3 years (Stiff neck, 24/7 tinnitus, visual snow, peripheral neuropathy, brain fog and many more. I am making progress though it is very slow.

    All these came alive after a course of antibiotics

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