CSF rhinorrhea

= = CSF Rhinorrhea == CSF Rhinorrhea, or cerebrospinal fluid rhinorrhea, is a condition characterized by the leakage of cerebrospinal fluid (CSF) from the subarachnoid space into the nasal cavity. This occurs due to a defect in the skull base, which allows the fluid to escape through the nose. CSF rhinorrhea is a rare but potentially serious condition that requires prompt diagnosis and management.

Etiology

CSF rhinorrhea can be caused by a variety of factors, including:

• Trauma: Head injuries, particularly those involving the skull base, are a common cause of CSF leaks. Skull fractures can create a pathway for CSF to escape.
• Surgical Complications: Procedures involving the brain or sinuses can inadvertently create defects in the skull base.
• Spontaneous Causes: In some cases, CSF rhinorrhea occurs without an obvious cause, possibly due to increased intracranial pressure or congenital defects.
• Tumors: Certain tumors can erode the skull base, leading to CSF leakage.

Clinical Presentation

Patients with CSF rhinorrhea typically present with:

• Clear, Watery Nasal Discharge: The hallmark symptom is a persistent, clear nasal discharge that is often unilateral.
• Salty Taste: Patients may report a salty taste in the mouth due to the CSF.
• Headache: Some patients experience headaches due to changes in intracranial pressure.
• Risk of Meningitis: The communication between the nasal cavity and the subarachnoid space increases the risk of meningitis.

Diagnosis

The diagnosis of CSF rhinorrhea involves several steps:

• Clinical Examination: A thorough history and physical examination are essential.
• Beta-2 Transferrin Test: This test is highly specific for CSF and can confirm the presence of CSF in the nasal discharge.
• Imaging Studies: CT and MRI scans can help identify the site of the leak and any underlying causes.
• Intrathecal Fluorescein: In some cases, fluorescein dye is injected into the CSF to help visualize the leak during endoscopic examination.

Management

The treatment of CSF rhinorrhea depends on the cause and severity of the leak:

• Conservative Management: Bed rest, head elevation, and avoidance of activities that increase intracranial pressure may allow spontaneous closure of the leak.
• Surgical Repair: Persistent leaks often require surgical intervention to repair the defect in the skull base. Endoscopic techniques are commonly used.
• Antibiotics: Prophylactic antibiotics may be used to prevent meningitis, although their routine use is debated.

Prognosis

The prognosis for CSF rhinorrhea is generally good with appropriate treatment. Surgical repair is successful in the majority of cases, and the risk of complications such as meningitis can be minimized with timely intervention.

See Also

• Meningitis
• Skull fracture
• Endoscopic sinus surgery

NIH genetic and rare disease info

• NIH info on CSF rhinorrhea

CSF rhinorrhea is a rare disease.