Cerebrospinal fluid rhinorrhoea

Leakage of cerebrospinal fluid from the nose

Cerebrospinal fluid rhinorrhoea 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.

Pathophysiology

Cerebrospinal fluid rhinorrhoea results from a breach in the dura mater, the outermost membrane surrounding the brain and spinal cord. This breach can occur due to trauma, surgery, tumors, or congenital defects. The defect allows CSF to leak into the paranasal sinuses and subsequently into the nasal cavity, leading to a persistent watery nasal discharge.

Causes

The causes of cerebrospinal fluid rhinorrhoea can be classified into:

• Traumatic: This is the most common cause and includes head injuries such as skull fractures.
• Iatrogenic: Resulting from surgical procedures involving the sinuses or brain.
• Spontaneous: Occurs without any apparent cause, often associated with intracranial hypertension.
• Congenital: Due to developmental defects in the skull base.

Symptoms

The primary symptom of cerebrospinal fluid rhinorrhoea is a clear, watery nasal discharge that is often unilateral. Other symptoms may include:

• Headache
• Meningitis
• Visual disturbances
• Tinnitus

Diagnosis

Diagnosis of cerebrospinal fluid rhinorrhoea involves:

• Clinical examination: Observing the characteristics of the nasal discharge.
• Laboratory tests: Testing the fluid for beta-2 transferrin, a protein specific to CSF.
• Imaging studies: CT scan or MRI to identify the site of the leak.

Treatment

Treatment options for cerebrospinal fluid rhinorrhoea include:

• Conservative management: Bed rest, head elevation, and avoidance of activities that increase intracranial pressure.
• Surgical repair: Endoscopic repair of the skull base defect is often required if conservative measures fail.

Complications

If left untreated, cerebrospinal fluid rhinorrhoea can lead to serious complications such as:

• Meningitis
• Brain abscess
• Pneumocephalus

Prognosis

With appropriate treatment, the prognosis for cerebrospinal fluid rhinorrhoea is generally good. Surgical repair has a high success rate, and most patients recover without significant complications.

Related pages

• Cerebrospinal fluid
• Meningitis
• Skull fracture