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CSF Rhinorrhea

condition

Definition

Cerebrospinal fluid (CSF) rhinorrhea is a condition where the protective fluid that surrounds the brain finds its way into the nose and sinuses, often appearing as a very watery runny nose.

Most cases of CSF rhinorrhea occur after major accidents where the bones of the face and skull experience significant trauma. The majority of these leaks stop on their own, but surgery may be needed if the leaking continues after 48-72 hours.

Spontaneous CSF Rhinorrhea

Some patients can develop spontaneous CSF rhinorrhea. This may be the because of idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, where high pressure inside the skull eventually creates small holes between the nose and the area where the brain rests. Spontaneous CSF rhinorrhea is also associated with the presence of meningoceles or encephaloceles in the nose, which occurs when portions of the lining of the brain (called the meninges), and sometimes small pieces of brain itself, can also push through those holes that were created. 

Risk

Risks of CSF rhinorrhea include the possibility of developing meningitis, an infection of the lining of the brain. Because of this, it's important to see your doctor as soon as possible.

Antibiotics haven't been shown to reduce the risk and aren't recommended on a regular basis unless signs of meningitis appear.

Symptoms

Depending on the size of the leak, patients may note a continual salty taste and a sense of drainage in the throat or watery drainage from the nose. Bending over and increased activity can make these symptoms worse.

Many people will also notice changes in vision, headaches, ringing in the ears and dizziness. There are other causes for these problems, as well as for watery drainage from the nose, so it is important to see your doctor to help determine the cause of your symptoms.

diagnosis

Diagnosis

The diagnosis of CSF rhinorrhea usually requires testing the drainage from the nose for a protein called Beta-2 or Tau transferring. This protein is only found in brain fluid.

Once there is a diagnosis, your doctor may order several other tests to determine the location of the leak. A CT scan of the head and sinuses often reveals the source of the leak and helps the surgeon plan any needed surgery.

Additional tests may be needed, including a lumbar puncture (spinal tap), where dye is used to help pinpoint the area of the leak.

Your doctor may also have you evaluated by other doctors to look for any other issues, such as hearing or vision loss, high blood pressure and high intracranial pressure. Tests may include an eye exam, hearing tests and lumbar punctures to measure the pressure of the fluid surrounding your brain and spinal cord.

treatment

Treatment

Treatment is designed to stop fluid leakage. This often requires surgery, but in some cases bed rest and medication may be all that's needed.

Medications

Medications can be used to help decrease the production of the fluid that surrounds the brain (cerebrospinal fluid or CSF). This reduces the pressure and allows the leak to seal. Acetazolamide, a carbonic anhydrase inhibitor, is usually used.

Surgery

Surgery is often needed and can be performed using small tools and cameras (endoscopes), which are placed up the nostrils and into the nose. The doctor may use skin or bone from inside your nose or small pieces of fat from your abdomen to help repair the leak.

A hospital stay of 2-3 days is often needed. Some patients may need additional surgery if the first surgery is not successful.

To help reduce pressure in the brain while the repair is healing, your surgeon may use temporary shunts. These shunts are designed to drain off excess fluid.

prevention

Prevention

The causes of spontaneous CSF rhinorrhea are not completely known, but the condition is associated with obesity and high blood pressure.

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