Cerebrospinal fluid rhinorrhoea: Difference between revisions

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{{Short description|Leakage of cerebrospinal fluid from the nose}}
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'''CSF rhinorrhoea''' refers to the drainage of [[cerebrospinal fluid]] through the [[Human nose|nose]]. Measures of CSF components such as glucose have been used in the past, but are neither sensitive nor specific; beta-2 transferrin, however, has been shown to have a high [[positive predictive value]].<ref>{{cite journal |doi=10.1016/j.otc.2005.03.011 |pmid=16005720 |title=Cerebrospinal Fluid Rhinorrhea: Diagnosis and Management |journal=Otolaryngologic Clinics of North America |volume=38 |issue=4 |pages=597–611 |year=2005 |last1=Kerr |first1=Julie T. |last2=Chu |first2=Felix W.K. |last3=Bayles |first3=Stephen W. }}</ref> It has also been noted to be characterized by unilateral discharge.<ref name=EMedicine861126>{{EMedicine|article|861126|CSF Rhinorrhea}}</ref>


It is a sign of a [[basilar skull fracture]]. Management includes [[watchful waiting]] – leaks often stop spontaneously; if this does not occur then neurosurgical closure is necessary to prevent the spread of infection to the meninges.<ref name=EMedicine861126/>
'''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]].


Other signs of a basilar skull fracture includes CSF otorrhoea (drainage of CSF through the ear). It can have devastating complications in some patients, as the communication between the nasal cavity and the cerebrospinal fluid and CNS can result in bacterial infections of the CNS that can have catastrophic effects on the patient.<ref name=EMedicine861126/>
==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.


CSF rhinorrhoea can also be a symptom of a [[pituitary adenoma]].{{fact|date=May 2015}}
==Causes==
The causes of cerebrospinal fluid rhinorrhoea can be classified into:


'''Spontaneous CSF rhinorrhea'''. The most common congenital or acquired defect in the skull base bones (anterior cranial fossa) at the [http://www.minclinic.ru/cns/cns_eng/spontannaya_likvoreya_eng.html spontaneous nasal liquorrhea] localized in following formation:
* '''Traumatic''': This is the most common cause and includes [[head injuries]] such as skull fractures.
* sphenoid sinus (43%)
* '''Iatrogenic''': Resulting from [[surgical procedures]] involving the [[sinuses]] or [[brain]].
* ethmoid bone (29%)
* '''Spontaneous''': Occurs without any apparent cause, often associated with [[intracranial hypertension]].
* cribriform plate (29%)
* '''Congenital''': Due to developmental defects in the skull base.


==See also==
==Symptoms==
*[[Beta-2 transferrin]]
The primary symptom of cerebrospinal fluid rhinorrhoea is a clear, watery nasal discharge that is often unilateral. Other symptoms may include:
*[[Meningitis]]
*[[Traumatic head injury]]


==References==
* [[Headache]]
{{reflist}}
* [[Meningitis]]
== External links ==
* [[Visual disturbances]]
{{Medical resources
* [[Tinnitus]]
|  DiseasesDB      =
|  ICD10          =G96.0
|  ICD9            = {{ICD9|349.81}}
|  ICDO            =
|  OMIM            =
|  MedlinePlus    =
|  eMedicineSubj  = article
|  eMedicineTopic  = 861126
|  MeshID          =
|  GeneReviewsName =
}}
{{CNS diseases of the nervous system}}


[[Category:Body fluids]]
==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.


{{nervoussystem-disease-stub}}
==Treatment==
{{dictionary-stub1}}
Treatment options for cerebrospinal fluid rhinorrhoea include:
<gallery>
 
File:Head_olfactory_nerve.jpg
* '''Conservative management''': Bed rest, head elevation, and avoidance of activities that increase [[intracranial pressure]].
</gallery>
* '''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]]
 
[[Category:Neurology]]
[[Category:Otorhinolaryngology]]
[[Category:Medical conditions related to the nervous system]]

Revision as of 19:12, 22 March 2025

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:

Symptoms

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

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:

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

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