Cerebrospinal fluid rhinorrhoea
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.
| Cerebrospinal fluid rhinorrhoea | |
|---|---|
| Specialty | Neurology, neurosurgery, otorhinolaryngology |
| 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 |
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]
- Aldroubi sign "The liquid in CSF rhinorrhea is thin and clear, and an affected person might notice a sweet or salty taste due to the increased glucose and electrolytes present in cerebrospinal fluid so some affected toddlers and young children tend to lick their nose frequently".
Causes
Traumatic
CSF rhinorrhoea may be a sign of a basilar skull fracture. Other signs of a basilar skull fracture include CSF otorrhoea (drainage of CSF through the ear). 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.
References
- 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.
- Makhmurian, Meri S. (23 September 2020). "MIN — Spontaneous cranial cerebrospinal fluid leak (CSF liquorrhea)". www.minclinic.ru. Archived from the original on 2014-11-27. Retrieved 2021-10-09.
- CSF Rhinorrhea at eMedicine
- 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.