Rhinorrhea cerebrospinal fluid (brain to nose)

Ear Nose | Neurology | Rhinorrhea cerebrospinal fluid (brain to nose) (Disease)


CSF rhinorrhoea refers to the drainage of cerebrospinal fluid through the 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. It is a sign of basal skull fracture.

Causes and Risk factors

A basal skull fracture is the most common cause. However, aggressive lesions (such as inverted papilloma) and malignant neoplasms can erode or invade the bone of the anterior cranial fossa.

Defects in the closure of the anterior neuropore can result in the herniation of central nervous tissue through anterior cranial fossa skull base defects.

Diagnosis and Treatment

Most surgeons would recommend obtaining high resolution computer tomography (CT) scans in all cases of suspected skull base defects for their ability to detect bony defects. They can also detect the presence of pneumocephalus, soft tissue masses, and hydrocephalus.

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. ...