Cerebrospinal fluid rhinorrhoea

Last updated
Cerebrospinal fluid rhinorrhoea
Specialty Neurology, neurosurgery, otorhinolaryngology,Oral and maxillofacial surgery
Symptoms clear, colourless liquid draining from nose
Complications infection
Causes basilar skull fracture
Diagnostic method brain scans, testing nasal discharge to see if it is CSF
Differential diagnosis other types of rhinorrhoea
Treatment conservative management: observation neurosurgery: repairing any skull fracture
Head olfactory nerve.jpg

Cerebrospinal fluid rhinorrhoea (CSF rhinorrhoea) refers to the drainage of cerebrospinal fluid through the nose (rhinorrhoea). It is typically caused by a basilar skull fracture, which presents complications such as infection. It may be diagnosed using brain scans (prompted based on initial symptoms), and by testing to see if discharge from the nose is cerebrospinal fluid. Treatment may be conservative (as many cases resolve spontaneously), but usually involves neurosurgery.

Contents

Classification

CSF rhinorrhoea may be spontaneous, traumatic, or congenital. [1]

Traumatic CSF rhinorrhoea is the most common type of CSF rhinorrhoea. [1] It may be due to severe head injury, or from complications from neurosurgery. [1]

Spontaneous CSF rhinorrhoea is the most common acquired defect in the skull base bones (anterior cranial fossa) causing spontaneous nasal liquorrhea. Defects are often localized in the sphenoid bone and the ethmoid bone. [1]

Congenital CSF rhinorrhoea is the least common type of CSF rhinorrhoea. [1] It may be caused by problems in the embryological development of bones of the skull. [1]

Signs and symptoms

CSF rhinorrhoea involves drainage of cerebrospinal fluid through the nose. [1] This appears as a clear, colourless liquid. [1]

Causes

Traumatic

CSF rhinorrhoea may be a sign of a basilar skull fracture. Other signs of a basilar skull fracture include CSF otorrhea (drainage of CSF through the ear). [2] It can have devastating complications in some patients, as the communication between the nasal cavity, the cerebrospinal fluid and the central nervous system can result in severe bacterial infections. [3]

CSF rhinorrhoea may be a complication of neurosurgery, such as functional endoscopic sinus surgery, and hypophysectomy (partial or complete removal of the pituitary gland). [1]

Non-traumatic

CSF rhinorrhoea may be caused by the growth of certain cancers (such as pituitary adenoma), congenital problems with bones of the skull, or inflammation that damages the bones of the skull. [1]

Diagnosis

Radiology

If a patient has clear, colourless liquid leaking from the nose, then radiographs or CT scans may be used to look for a basilar skull fracture.

Biochemistry

Measures of CSF components, such as glucose, have been used in the past, but are neither sensitive nor specific. Beta-2 transferrin has a high positive predictive value of CSF rhinorrhoea. [4] It has also been noted to be characterized by unilateral discharge. [3]

Treatment

Surgery

Neurosurgery is usually necessary to prevent the spread of infection to the meninges. [1] [3] Minimally invasive techniques tend to have fewer complications compared to open techniques. [1]

Conservative management

Conservative management includes watchful waiting, as some minor CSF leaks often stop spontaneously.

See also

Related Research Articles

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<span class="mw-page-title-main">Cerebrospinal fluid</span> Clear, colorless bodily fluid found in the brain and spinal cord

Cerebrospinal fluid (CSF) is a clear, colorless body fluid found within the tissue that surrounds the brain and spinal cord of all vertebrates.

<span class="mw-page-title-main">Hydrocephalus</span> Abnormal increase in cerebrospinal fluid in the ventricles of the brain

Hydrocephalus is a condition in which an accumulation of cerebrospinal fluid (CSF) occurs within the brain. This typically causes increased pressure inside the skull. Older people may have headaches, double vision, poor balance, urinary incontinence, personality changes, or mental impairment. In babies, it may be seen as a rapid increase in head size. Other symptoms may include vomiting, sleepiness, seizures, and downward pointing of the eyes.

<span class="mw-page-title-main">Craniotomy</span> Surgical operation on skull

A craniotomy is a surgical operation in which a bone flap is temporarily removed from the skull to access the brain. Craniotomies are often critical operations, performed on patients who are suffering from brain lesions, such as tumors, blood clots, removal of foreign bodies such as bullets, or traumatic brain injury, and can also allow doctors to surgically implant devices, such as deep brain stimulators for the treatment of Parkinson's disease, epilepsy, and cerebellar tremor. The procedure is also used in epilepsy surgery to remove the parts of the brain that are causing epilepsy.

<span class="mw-page-title-main">Cribriform plate</span> Part of the ethmoid bone in the skull

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<span class="mw-page-title-main">Skull fracture</span> Medical condition

A skull fracture is a break in one or more of the eight bones that form the cranial portion of the skull, usually occurring as a result of blunt force trauma. If the force of the impact is excessive, the bone may fracture at or near the site of the impact and cause damage to the underlying structures within the skull such as the membranes, blood vessels, and brain.

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<span class="mw-page-title-main">Cerebral shunt</span> Surgical implant to treat hydrocephalus

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<span class="mw-page-title-main">Le Fort fracture of skull</span> Type of head injury

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<span class="mw-page-title-main">External ventricular drain</span> Medical device

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<span class="mw-page-title-main">Hemotympanum</span> Presence of blood in the tympanic cavity of the middle ear

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<span class="mw-page-title-main">Cerebrospinal fluid leak</span> Leakage of fluid surrounding the brain and spinal cord through tears in the dura mater

A cerebrospinal fluid leak is a medical condition where the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord leaks out of one or more holes or tears in the dura mater. A CSF leak is classed as either spontaneous (primary), having no known cause, or nonspontaneous (secondary) where it is attributed to an underlying condition. Causes of a primary CSF leak are those of trauma including from an accident or intentional injury, or arising from a medical intervention known as iatrogenic. A basilar skull fracture as a cause can give the sign of CSF leakage from the ear, nose or mouth. A lumbar puncture can give the symptom of a post-dural-puncture headache.

<span class="mw-page-title-main">Aqueductal stenosis</span> Narrowing of the aqueduct of Sylvius

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References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 Banks, Caroline A.; Palmer, James N.; Chiu, Alexander G.; O'Malley, Bert W.; Woodworth, Bradford A.; Kennedy, David W. (2009-06-01). "Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years". Otolaryngology–Head and Neck Surgery. 140 (6): 826–833. doi:10.1016/j.otohns.2008.12.060. ISSN   0194-5998.
  2. "CSF Otorrhea: Practice Essentials, Epidemiology, Etiology". 28 November 2023. Retrieved 13 January 2024.
  3. 1 2 3 CSF Rhinorrhea at eMedicine
  4. Kerr, Julie T.; Chu, Felix W.K.; Bayles, Stephen W. (2005). "Cerebrospinal Fluid Rhinorrhea: Diagnosis and Management". Otolaryngologic Clinics of North America. 38 (4): 597–611. doi:10.1016/j.otc.2005.03.011. PMID   16005720.