Cerebrospinal fluid (CSF) rhinorrhea is the medical term for a rare condition in which the fluid that normally softens the brain and spinal cord, cerebrospinal fluid, flows through the nose.
It occurs when an abnormal pathway is inadvertently created between the brain's subarachnoid space and the sinus cavities, which can be caused by a variety of factors, including surgery and trauma.
A clear, watery rhinorrhea ( runny nose ) may be the first sign of a cerebrospinal fluid rhinorrhea. Other signs and symptoms may include:
- Salty or metallic taste in the mouth
- Drainage increases when you lean forward with your head down
- Odorless (anosmia)
- Nasal congestion
It is important to understand that these symptoms also occur in many other more common conditions and should be evaluated by a treating physician or otolaryngologist (ear, nose, throat, or ENT specialist) if they are not easy to explain or are not clear to recognize later. a week or so.
If you have the symptoms listed above, you should not postpone the exam, as cerebrospinal fluid rhinorrhea can lead to serious complications.
An abnormal space that leaks CSF can be caused by:
- Complication of sinus surgery
- Some birth defects
- Increased intracranial pressure (ICP) (also called spontaneous cerebrospinal fluid rhinorrhea)
- Injury to the head and face that causes a fracture of the nasoorbitoethmoid bone and damage to the ethmoid plate (the part of the frontal lobe that forms the "roof" of the sinus)
The exact incidence of cerebrospinal fluid rhinorrhea is unknown, but some studies have shown that the incidence of complications associated with cerebrospinal fluid rhinorrhea after sinus surgery is rare, as low as 0.5%. Fortunately, since the introduction of seat belt laws, the incidence of CSF rhinorrhea due to trauma has also decreased.
If you experience any of the above symptoms, you should seek the advice of your doctor or otolaryngologist. If you had surgery, you should see the surgeon who performed it.
However, if you have not had sinus surgery, any CT scans or other x-ray images of your sinuses that you have had in the past should be done and taken to an ENT specialist for evaluation.
During this appointment, you may be asked to perform an odor test to determine if there is an olfactory (odor) dysfunction. This test can be done before any treatment to determine initial function.
Your healthcare provider may also choose to have an endoscopy , depending on your situation. This includes the use of a small fiberoptic probe to visualize any abnormalities in the upper nasal cavity and the ethmoid plate.
Other tests your healthcare provider may order include:
- Computed tomography
- Magnetic resonance
- Transferrin Β-2 test (nasal drainage lab test) to confirm that the substance is actually cerebrospinal fluid.
- The radioactive content scan is a time-consuming imaging test and involves inserting a medical cotton ball into the nose and ears followed by a lumbar puncture.
- Intrathecal fluorescein can be used both to detect CSF leaks and to repair them surgically.
If you have cerebrospinal fluid rhinorrhea, it is important that you receive proper treatment to prevent meningitis ( sometimes a very serious infection) or pneumocephalus (air in the skull cavity).
Very small leaks may require only bed rest and treatment. However, in most cases, surgery is necessary to treat cerebrospinal fluid rhinorrhea.
The type of surgery you need depends on the cause of your condition (surgery or injury). The success rate is good, but complications can arise with any surgical procedure, especially when general anesthesia is used.
You should discuss the risks and benefits of surgery with your healthcare provider and follow their instructions regarding fasting the day before and on the day of surgery, as well as instructions on how to care for yourself after the procedure.
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Although cerebrospinal fluid rhinorrhea is rare, its complications (such as meningitis) can be serious and should not be taken lightly. Be sure to seek medical attention as soon as you notice symptoms.