Welcome to the Cranial CSF Leak Resource Hub
Page Contents
Cranial cerebrospinal fluid (CSF) leaks are a challenging condition that many patients and even healthcare providers struggle to identify and manage. These leaks occur when CSF escapes through a tear or hole in the dura mater, the membrane surrounding the brain, leading to a range of symptoms that can significantly impact quality of life. Unfortunately, cranial CSF leaks are often misdiagnosed, with symptoms attributed to conditions like chronic allergies, sinus infections, or migraines. This misconception can delay critical treatment and lead to complications, including meningitis, a serious risk that you can learn more about on our dedicated page.
Despite growing awareness of CSF leaks, comprehensive information about cranial leaks remains scarce. While there are some general resources available, they often lack the depth and specificity needed to address cranial cases. This scarcity underscores the importance of the Target CSF Leaks hub as a leading source for accurate, detailed, and patient-focused information about cranial CSF leaks. We aim to fill the void by providing resources that educate, empower, and guide patients toward proper care.
Additionally, there are several misconceptions about cranial CSF leaks that can hinder proper care. These include the belief that symptoms like clear nasal discharge are always due to allergies or sinus issues, underestimating the severity of untreated leaks, and a lack of awareness among healthcare providers about reliable diagnostic tools such as beta-2 transferrin testing. Addressing these misconceptions is vital to ensuring timely and effective treatment.
This resource hub is designed to empower patients and their families with accurate information about cranial CSF leaks, provide practical advice for navigating the healthcare system, and offer emotional and psychological support during what can be a difficult journey. By raising awareness and advocating for proper care, we can help ensure that cranial CSF leaks are recognized and treated appropriately.
If you come across additional credible resources or research, please let us know so we can continue to expand and improve this hub for the benefit of the cranial CSF leak community.
Explore Our Sections
- Understanding Cranial CSF Leaks: Covers symptoms, causes, and common misconceptions.
- Diagnosis and Treatment: Outlines key diagnostic methods and treatment options, from initial testing to surgery.
- Beta 2 Transferrin Testing: The gold standard for confirming a cranial CSF leak. Find out how to go about it and where testing locations are.
- Navigating the Healthcare System: Offers guidance on finding experienced specialists, accessing reliable diagnostic tests, and using member-exclusive templates to assist with healthcare communication and advocacy.
- Emotional and Psychological Support: Includes resources tailored to managing the challenges unique to cranial leaks.
- Raising Awareness: Empowers users to educate others and support broader recognition of the condition.
- Access Templates for Assistance: Members can find templates for requests or complaints in the Members Lounge, if needed.
Understanding Cranial CSF Leaks
Cranial CSF leaks occur when there is a breach in the protective layer surrounding the brain, allowing CSF to escape through the nose (rhinorrhoea) or ears (otorrhea).
A major challenge for cranial CSF leak patients is misdiagnosis. These leaks are often mistaken for conditions like chronic allergies, sinus infections, or migraines. Testing methods like beta-2 transferrin analysis and high-resolution imaging (e.g., CT or MRI scans) can confirm the presence of a cranial CSF leak, but awareness of these diagnostic tools is limited among some healthcare providers.
Symptoms
Cranial CSF leaks can present with a variety of symptoms, often making them difficult to diagnose without proper testing. Common symptoms include:
- Clear, Watery Nasal Discharge (Rhinorrhea): Fluid draining from one or both nostrils, often worse with bending forward or physical activity. This discharge may increase during coughing, sneezing, or straining.
- Clear Fluid from the Ear (Otorrhea): In cases where the leak involves the temporal bone or ear structures, clear fluid may drain from the ear.
- Orthostatic Headaches: Severe headaches that worsen when upright and improve when lying down. These are classic indicators of low CSF pressure.
- Tinnitus and Hearing Changes: Ringing in the ears or muffled hearing may occur, especially if the leak affects the ear structures.
- Visual Disturbances: Blurred or double vision can result from changes in CSF pressure impacting the cranial nerves or intracranial structures.
- Neck Stiffness or Nausea: In more severe cases, symptoms may include neck stiffness, nausea, or photophobia, which can mimic signs of meningitis.
- Recurrent Meningitis: Persistent or recurrent episodes of meningitis may be a red flag for an undiagnosed cranial CSF leak.
Causes
The causes of cranial CSF leaks vary, but they generally fall into the following categories:
- Trauma:
- Head injuries, such as skull fractures or severe concussions, can result in a tear in the dura mater.
- Surgical procedures involving the skull base, sinuses, or ear structures may unintentionally create a CSF leak.
- Spontaneous Leaks:
- Occur without a clear cause but may be linked to conditions like idiopathic intracranial hypertension (IIH), which can weaken the dura mater.
- Connective tissue disorders such as Ehlers-Danlos syndrome increase the likelihood of spontaneous leaks due to weakened connective tissues.
- Iatrogenic Causes:
- Medical procedures, including sinus or skull base surgeries and lumbar punctures, can result in unintended cranial CSF leaks.
- Malformations of the Inner Ear:
- Structural abnormalities such as an enlarged vestibular aqueduct or incomplete development of the cochlear and vestibular apparatus can predispose individuals to cranial CSF leaks.
- These malformations can create pathways for CSF to escape into the middle ear or nasal passages.
Common Misconceptions
Addressing misconceptions is critical for early diagnosis and effective treatment:
- “It’s Just Allergies”:
- Clear nasal discharge is often mistaken for chronic allergies or sinusitis. Unlike allergies, CSF rhinorrhea is typically watery and positional, increasing when leaning forward or during physical exertion.
- “Cranial CSF Leaks Are Harmless”:
- Some believe cranial leaks are minor issues. However, untreated leaks can lead to severe complications, including life-threatening infections like meningitis.
- Diagnostic Challenges:
- Many healthcare providers are unaware of specific tests like beta-2 transferrin, a reliable marker for CSF in nasal discharge, leading to missed diagnoses.
- Imaging Misconceptions:
- Standard imaging (e.g., CT or MRI) may not always detect leaks. Advanced imaging techniques, such as CT cisternography or MRI cisternography, are often required for confirmation.
- Underestimating Spontaneous Leaks:
- Spontaneous leaks are often overlooked or dismissed due to a lack of awareness about their connection to underlying conditions like IIH or connective tissue disorders.
Expanding awareness about these symptoms, causes, and misconceptions can significantly improve diagnosis rates and ensure timely, appropriate treatment for cranial CSF leaks.
🚨 Risks and Complications 🚨
If left untreated, cranial CSF leaks can lead to serious complications. One of the most significant risks is meningitis, an infection of the protective membranes around the brain. When CSF is leaking, bacteria can enter the space that’s normally sealed off, raising the risk of infection.
Learn how to recognise early signs and what action to take on our dedicated Meningitis Resource Page.
Diagnosis and Treatment of Cranial CSF Leaks
Diagnosing cranial CSF leaks can be challenging due to the varied symptoms, which often overlap with other conditions such as migraines, sinus issues, and allergies. The first step in diagnosis is a thorough assessment of the patient’s history and symptoms, followed by targeted diagnostic tests.
Diagnosis of Cranial CSF Leaks
- Beta-2 Transferrin Testing: This is the most specific test for confirming a CSF leak, particularly when there is clear nasal or ear discharge. Beta-2 transferrin is a protein found only in CSF, making it a highly accurate indicator of a CSF leak.
- Thin-Sliced CT Scan: A thin-sliced CT scan of the skull base can help identify structural abnormalities, such as fractures, which may lead to a CSF leak. It is particularly useful for detecting bone defects around the sinuses or other areas where leaks may occur.
- Brain MRI: Is commonly used to assess cranial CSF leaks, especially in cases where the leak is not immediately apparent. Gadolinium contrast may be used in certain cases, but an MRI without contrast is often sufficient to identify key signs of a CSF leak.
- CT Cisternography: If the above tests do not provide conclusive results, CT cisternography may be employed. This test involves injecting a small amount of contrast dye into the CSF to track its movement and pinpoint the leak site.
Beta-2 Transferrin Testing: What you need to know.
Beta-2 transferrin testing is the gold standard for confirming a cranial CSF leak. This test detects beta-2 transferrin, a protein found only in CSF, making it highly reliable for distinguishing CSF from other bodily fluids.
Why is This Test Important?
A cranial CSF leak can lead to serious complications, including meningitis. Early and accurate diagnosis through beta-2 transferrin testing helps guide treatment and prevent further health risks.
How to Get Tested
- Obtain a Referral – Your GP or specialist (e.g., ENT, neurologist) must request the test.
- Provide a Fluid Sample – A sterile container is required to collect clear fluid from your nose or ear.
- Blood Sample May Be Needed – A blood test is usually required alongside the fluid sample to confirm the presence of beta-2 transferrin.
- Submit the Sample – Your GP or hospital will arrange for the sample to be sent to a specialised lab for analysis.

Cranial CSF Leak Sample Collection Guide & Tube (UK ONLY)
NHS Hospitals Offering Beta-2 Transferrin Testing
Beta-2 transferrin testing is available at select NHS hospitals, including:
- Synnovis (Guy’s and St Thomas’ NHS Foundation Trust)
- Address: Guy’s Hospital, Great Maze Pond, London, SE1 9RT
- The Walton Centre, Liverpool
- Address: Lower Lane, Fazakerley, Liverpool, L9 7LJ
- Note: Beta-trace protein may be tested first; beta-2 transferrin is used for confirmation.
- St George’s University Hospitals NHS Foundation Trust(South West London Pathology)
- Address: Blackshaw Road, Tooting, London, SW17 0QT
- Sheffield Teaching Hospitals NHS Foundation Trust (Protein Reference Unit)
- Address: PO BOX 894, Sheffield, S5 7YT
- Leeds Teaching Hospitals NHS Trust
- Address: Leeds General Infirmary, Great George Street, Leeds, LS1 3EX
- South Tees Hospitals NHS Foundation Trust (The James Cook University Hospital)
- Address: Marton Road, Middlesbrough, TS4 3BW
- University Hospitals Plymouth NHS Trust (Derriford Hospital)
- Address: Derriford Road, Plymouth, Devon, PL6 8DH
- North Bristol NHS Trust (Southmead Hospital)
- Address: Pathology Sciences Building, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB
- Worcestershire Royal Hospital
- Address: Charles Hastings Way, Worcester, WR5 1DD
- National Hospital for Neurology and Neurosurgery (NHNN), London
- Address: Queen Square, London, WC1N 3BG
Hospitals That Send Samples Elsewhere for Testing
- York and Scarborough Teaching Hospitals NHS Foundation Trust(Samples sent to Sheffield for analysis)
- Address: Wigginton Road, York, YO31 8HE
- Gloucestershire Hospitals NHS Foundation Trust(Samples sent to North Bristol for analysis)
- Address: Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN
If you are unable to access testing at these locations, speak to your GP about alternative NHS options or private testing. Many NHS hospitals send samples to centralised labs, so it’s always best for patients to check with their GP or local hospital pathology department.
Private Hospitals Offering Beta-2 Transferrin Testing
1. Harley Street ENT Clinic
- Location: London
- Details: The Harley Street ENT Clinic offers nasal fluid beta-2 transferrin assays. Given the specialised nature of this test, samples are sent to the Department of Neuro-immunology at The National Hospital, Queen Square, for analysis.
- Website: The Harley Street ENT
2. King’s College Hospital
- Location: King’s College Hospital, Denmark Hill, London, SE5 9RS
- Details: King’s College Hospital, through Synnovis, offers beta-2 transferrin testing to detect CSF leaks. The test is performed using the Hydragel 6 B2 Transferrin(e) assay, which employs electrophoresis and immunofixation techniques to identify beta-2 transferrin. This is a crucial test for diagnosing conditions such as CSF rhinorrhoea or otorrhea.
- Website: Synnovis – Beta-2 Transferrin Testing

Cisternography (Cisternogram) Procedure: A Detailed Explanation
Cisternography, also known as a cisternogram, is a diagnostic imaging technique used to locate cranial CSF leaks. It involves injecting a small amount of radioactive tracer into the cerebrospinal fluid (CSF) to track the flow of fluid and identify leaks, particularly in the skull base or cranial region.
Steps in the Cisternography Procedure:
- Lumbar Puncture (Spinal Tap):
- Injection Site: The procedure begins with a lumbar puncture, where a needle is inserted into the lumbar subarachnoid space.
- CSF Collection: A small amount of cerebrospinal fluid (CSF) is usually collected for analysis. This fluid surrounds the brain and spinal cord and is involved in the movement of the radioactive tracer.
- Tracer Injection: A radioactive tracer (often Technetium-99m or other suitable compounds) is injected into the CSF. The tracer is used because it can be easily detected using special imaging equipment (such as nuclear medicine scans or CT), allowing doctors to track its flow throughout the spinal column and up to the brain.
- Radiation and Imaging:
- Imaging: Once the tracer is injected into the CSF, it begins to move through the spinal canal and towards the brain. Imaging techniques such as CT scans or nuclear medicine imaging (SPECT) are used to track the tracer’s movement.
- The radioactive tracer is fluorescent and can be seen clearly under special imaging, allowing doctors to pinpoint any CSF leaks by observing where the tracer accumulates or escapes from the normal CSF pathway.
- Tracking the Tracer:
- The tracer flows upward from the lumbar region through the spinal cord and into the brain. The tracer helps identify any areas where cerebrospinal fluid may be leaking or where abnormal accumulations of fluid are present in the skull base, which can indicate a leak.
- The images produced during this phase help surgeons or specialists identify the exact location of the leak, especially in complex areas like the skull base.
Why Cisternography Is Used:
- CSF Leak Detection: Cisternography is employed when a cranial CSF leak is suspected but not easily visible through other imaging methods like MRI.
- Guidance for Surgery: The images produced by cisternography provide valuable information to guide surgeons in pinpointing the exact location of a cranial CSF leak, helping them plan a more accurate and effective intervention.
Risks and Considerations:
While cisternography can be very useful in diagnosing cranial CSF leaks, there are a few risks and challenges to be aware of:
- Discomfort: The procedure involves a lumbar puncture, which can cause discomfort or a headache. There may also be side effects from the radioactive tracer, such as nausea or dizziness.
- Radiation Exposure: Since the procedure involves the use of radioactive material, there is a small amount of radiation exposure. However, the amount used is typically very low and considered safe in diagnostic settings.
- Allergic Reactions: Though rare, some patients may experience mild allergic reactions to the radioactive tracer, resulting in skin irritation, itching, or more severe symptoms.
- Availability: Cisternography may not be readily available at all hospitals due to the need for specialised equipment and expertise. Additionally, due to the involvement of radioactive material, the procedure requires careful handling and strict safety protocols.
Why Hospitals May Be Hesitant to Perform Cisternography:
- Specialised Equipment: Hospitals may lack the necessary nuclear imaging equipment or trained staff to safely perform cisternography. This makes it a less common procedure compared to others, such as MRI or CT scans.
- Patient Discomfort: The lumbar puncture aspect of the procedure can be uncomfortable for some patients, and there may be concerns about the procedure’s invasiveness and potential side effects.
- Radiation Exposure: The use of radioactive material, while generally safe in small amounts, introduces a level of risk and may require additional safety measures, contributing to the reluctance of some hospitals to offer the procedure.
Summary:
Cisternography is a diagnostic tool that involves injecting a radioactive tracer into the cerebrospinal fluid to track its movement through the spine and to the brain. It is typically used when a cranial CSF leak is suspected but cannot be diagnosed with more common imaging methods. The procedure provides essential information to guide surgical interventions and help locate the exact position of the leak. However, due to its complexity, discomfort, and the use of radioactive material, some hospitals may be reluctant to offer it as a first-line diagnostic tool.
Treatment
Treatment for cranial CSF leaks aims to close the leak, alleviate symptoms, and prevent complications such as meningitis. A combination of conservative management and, when necessary, surgical intervention is typically employed.
- Conservative Treatments:
- Bed Rest: Resting in a horizontal position can reduce symptoms, particularly headaches, which often improve when lying down.
- Hydration: Increasing fluid intake may help improve CSF production and alleviate symptoms such as dizziness or headaches.
- Caffeine: Caffeine may help stimulate CSF production, providing mild relief for symptoms.
- Pain Management: Non-steroidal anti-inflammatory drugs (NSAIDs) or paracetamol can help manage headache pain and other symptoms.
- Surgical Treatments:
- Endoscopic Surgery: For leaks near the base of the skull or sinuses, endoscopic surgery is often required. This minimally invasive procedure uses a small camera to locate and seal the leak with a graft. Recovery time is usually quicker than for more invasive surgeries.
- Craniotomy: In more complex cases, a craniotomy may be necessary to access and repair the leak. This involves opening the skull to directly visualise the leak and perform the repair. It is typically used when the leak cannot be accessed through endoscopic surgery.
Surgical Techniques for Leak Localisation
Intrathecal Fluorescein: A Surgical Tool to Locate Cranial CSF Leaks
When a cranial CSF leak is suspected but difficult to pinpoint, surgeons may use a technique called intrathecal fluorescein just before or during surgery. This involves:
- Performing a lumbar puncture to withdraw a small amount of cerebrospinal fluid (CSF)
- Adding a special diluted fluorescein dye to the CSF
- Re-injecting the fluorescein-laced fluid into the spine
- Allowing the dye to circulate with the CSF to the brain and skull base
- Using a blue filter light during surgery (typically endoscopic sinus surgery) to detect fluorescent green CSF escaping from the leak site
This glowing green dye helps the surgical team visually confirm the location of the leak and guide precise repair. While very helpful, this procedure is highly specialised and carries some risks, so it is only done in selected cases by experienced teams.
Navigating the Healthcare System for Cranial CSF Leaks
Navigating the healthcare system with a cranial CSF leak can be daunting, particularly when symptoms are dismissed or misdiagnosed. Delays in diagnosis and treatment not only prolong suffering but also increase the risk of complications such as meningitis. This section offers a step-by-step guide to help patients secure the care they need:
🧠 Find the Right Specialists
Seek referrals to ear, nose and throat (ENT) specialists or neurosurgeons who have experience with cranial CSF leaks. Their expertise is essential for accurate assessment and targeted treatment planning.
🧪 Request the Correct Tests (in the Right Order)
- Start with thin-slice (high-resolution) CT and dedicated MRI scans of the skull base. These non-invasive imaging techniques are often the first step in detecting signs of a leak, such as fluid tracks or small defects.
- If you are actively leaking clear fluid from the nose or ear, request a beta-2 transferrin test — a highly specific marker for cerebrospinal fluid.
- If the diagnosis remains unclear, and suspicion of a leak persists, advanced imaging such as CT cisternography or MRI cisternography may be considered. These are more invasive and usually arranged by a specialist team.
📂 Prepare for Appointments
Bring along a concise symptom log, copies of past imaging or tests, and a written timeline of your condition. Organising your information helps clinicians see the full picture and take your concerns more seriously.
💬 Advocate for Yourself
Many cranial CSF leaks are mislabelled as allergies, rhinitis, or anxiety. If you feel you’re not being heard, ask for second opinions, request specific referrals, and come armed with credible information. Confidence and persistence are key — you deserve to be listened to.
🧰 Utilise Resources
In our members-only area, you’ll find symptom trackers, appointment templates, and correspondence tools. These can help you communicate more effectively with clinicians or lodge formal complaints if necessary.
By following these steps, patients can navigate the healthcare system more effectively and increase the likelihood of receiving timely and appropriate care. Patients with cranial CSF leaks often face hurdles in receiving timely and accurate diagnoses. Misdiagnoses such as “allergies” or “rhinitis” can delay essential treatment, prolonging symptoms and increasing the risk of complications like meningitis. Here are key steps to navigate the system:
- Identify Specialists: Seek referrals to ENT (ear, nose, and throat) specialists or neurosurgeons with experience in cranial CSF leaks. A specialist’s knowledge is often crucial for proper diagnosis and treatment.
- Access Testing: Request specific tests, such as beta-2 transferrin testing, which is a reliable marker for CSF in nasal fluid. Imaging techniques like CT cisternography may also be necessary.
- Persist in Advocacy: Be prepared to advocate for your symptoms to be taken seriously. Bring documentation, symptom logs, and information about cranial CSF leaks to appointments.
Empowering Yourself in Medical Consultations
Navigating consultations with healthcare providers can be daunting, especially when discussing a condition like cranial CSF leaks that is often misdiagnosed or misunderstood. Being prepared and confident in your approach can make a significant difference in achieving accurate diagnoses and effective treatment. Here are strategies to empower yourself in medical consultations:
- Be Specific and Thorough:
- Provide detailed descriptions of your symptoms, including when they occur, how they progress, and any factors that worsen or improve them.
- Highlight specific symptoms associated with cranial CSF leaks, such as orthostatic headaches or clear nasal/ear discharge that increases with activity or position changes.
- Keep a symptom diary to track patterns over time, which can serve as evidence during consultations.
- Share Reliable Information:
- Bring credible resources or summaries about cranial CSF leaks to share with your doctor, especially if they seem unfamiliar with the condition.
- Highlight key diagnostic tools like Beta-2 transferrin testing and advanced imaging techniques such as CT Cisternography.
- Ask Key Questions:
- Clarify the steps needed for a diagnosis and ask about specific tests, such as beta-2 transferrin analysis or targeted imaging.
- Inquire about treatment options, including surgical repairs or supportive measures, and the risks of untreated leaks.
- Request a referral to specialists, such as an ENT surgeon or neurosurgeon, if your symptoms persist or escalate.
- Advocate for Yourself:
- Politely but firmly express your concerns if your symptoms are dismissed or misattributed to allergies, sinus issues, or other common conditions.
- Prepare to request a second opinion if necessary. Persistence is often essential when seeking care for less commonly recognized conditions.
- Leverage Visual Aids:
- Diagrams or illustrations of cranial CSF leak anatomy and symptoms can help bridge communication gaps with your healthcare provider.
- Visual materials may make it easier to explain your condition and the impact on your quality of life.
- Bring Support:
- Consider bringing a family member, friend, or carer to appointments. They can help take notes, ask questions, and provide emotional support.
- An additional voice can reinforce the seriousness of your symptoms and ensure nothing is overlooked.
- Know Your Rights:
- Remember that as a patient, you have the right to ask questions, seek additional opinions, and advocate for tests or treatments that could improve your care.
By employing these strategies, you can ensure that your voice is heard and that your symptoms are taken seriously. Preparing thoroughly for medical consultations increases the likelihood of a timely and accurate diagnosis, as well as appropriate treatment, for cranial CSF leaks.
Emotional and Psychological Support
Living with a cranial CSF leak can be physically and emotionally challenging. Feelings of frustration, isolation, or anxiety are common, particularly when struggling to be heard by medical professionals. Here are some ways to manage these challenges:
- Connect with Others: Join support groups or forums where you can share experiences with others who understand the condition. Peer support can provide comfort and practical advice.
- Practice Self-Care: Engage in activities that promote relaxation and well-being, such as meditation, gentle yoga, or journaling. These can help manage stress and improve emotional resilience.
- Seek Professional Help: If feelings of anxiety or depression become overwhelming, consider speaking with a therapist who understands chronic illness.
Raising Awareness About Cranial CSF Leaks
Raising awareness is critical to improving recognition and treatment of cranial CSF leaks. Here’s how you can help:
- Share Your Story: Personal experiences can be powerful tools to educate others, including healthcare professionals.
- Distribute Informative Materials: Provide healthcare providers with brochures or quick-reference guides that explain cranial CSF leaks. Awareness campaigns can also be impactful.
- Participate in Advocacy: Support campaigns aimed at improving understanding and research into CSF leaks. This may involve fundraising, social media outreach, or engaging with policymakers.
Final Thoughts and Moving Forward
Cranial CSF leaks can undoubtedly be a complex and challenging condition to manage, both for patients and healthcare professionals. However, knowledge truly is power. The more informed patients and their families are, the better equipped they are to navigate the often difficult healthcare system. By having access to accurate, reliable resources and strong advocacy tools, patients can take control of their journey and advocate for themselves with confidence.
One of the most important aspects of dealing with a cranial CSF leak is persistence. Advocacy, both for better awareness of the condition and for access to appropriate treatments, is essential. It’s vital for patients to continue speaking up about their symptoms and pressing for the necessary diagnostic tests, especially when faced with misdiagnosis or delays in care. Every step toward greater awareness contributes to breaking down the barriers to diagnosis and treatment.
While the road to recovery can be long and fraught with challenges, it’s important to remain hopeful. Advances in medical research and technology are consistently improving the ways in which cranial CSF leaks are diagnosed, treated, and managed. As knowledge about the condition continues to grow, more patients will receive the care they need in a timely manner, leading to better outcomes and fewer complications.
By staying proactive, informed, and connected to support networks, patients can overcome the hurdles that cranial CSF leaks present. The future holds great promise for those affected, and with the continued efforts of advocacy and research, we can ensure that better care is accessible to all.
