CSF Rhinorrhoea
- Leakage of CSF into the nose
- May or may not be blood stained
- Trauma
- Accidental or surgical
- Surgical trauma
- Endoscopic sinus surgery
- Trans-sphenoidal hypophysectomy
- Nasal polypectomy
- Skull base surgery
- Inflammation
- Mucoceles of sinuses
- Sinonasal polyposis
- Fungal infection of sinuses
- Osteomyelitis
- Neoplasms
- Congenital lesions
- Meningocele
- Meningoencephaloceles
- Idiopathic
- History of clear watery discharge from the nose on bending the head or straining
- RESERVOIR SIGN: discharge from nose seen increased as patient rises in the morning as the fluid collected in the sinus empties into the nose
- Nasal endoscopy can help to localize CSF leak in some cases.
- Nasal secretions can be sniffed back while CSF can’t be sniffed back
- Handerkerchief doesn’t stiffen with CSF secretion ,but stiffens with nasal discharge as it is mucoid
- Double target sign: CSF fluid mixed with blood when dropped on a filter paper shows a central red dot surrounded by a lighter halo
- Laboratory test: presence of Beta-2 transferrin or beta trace proteins (proteins found in csf)
- High-resolution CT scan
- MRI
- Intrathecal fluorescein study
- CT cisternogram
6th edition : Diseases of ENT & HN surgery
PL Dhingra, Shruti Dhingra
Page no. 163-165
- Conservative measures
- Bed rest
- Elevating the head of the bed
- Stool softeners
- avoidance of nose blowing, sneezing and straining
- Prophylactic antibiotics can be used to prevent meningitis.
- Acetazolamide decreases CSF formation.
- Neurosurgical intracranial approach
- Extradural approaches
- Transnasal endoscopic approach
