Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Association for Physician Leadership, American Medical Association, Colorado Medical SocietyDisclosure: Nothing to disclose. All material on this website is protected by copyright, Copyright © 1994-2020 by WebMD LLC. Otolaryngol Clin N Am. Septal bone is used as an underlay graft in the repair of this skull base defect in a patient with a spontaneous leak and encephalocele. There are no other significant symptoms with CSF rhinorrhea. However, bed rest with simple measures to avoid coughing, sneezing and straining during bowel movement may achieve the desired result very effectively. Sense of smell is usually not affected. [Medline]. In a person with CSF rhinorrhea immediately after trauma, apart from surgery, the recommended approach is conservative management. 2017 Sep. 127 (9):2011-6. Sudden or profuse nasal discharge after an accident or injury should raise the concern about a CSF leak. Neurol India. [Medline]. J Neurosurg. A large defect is noted, and the meningocele has been resected. CSF rhinorrhea is an unusual condition that may occur after a traumatic head injury, as a complication of sinus or brain surgery, or as a result of a tumor or congenital birth defect. High impact injuries as seen with assault or motor vehicle accidents usually causes immediate CSF leaks. Surgery is another form of trauma but needs to be differentiated from penetrating and closed injuries to the head. Outcomes of endoscopic repair of cerebrospinal fluid rhinorrhea without lumbar drains. Lanny Garth Close, MD Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons After intrathecal fluorescein is administered, an exposed frontal recess encephalocele is seen. Diseases & Conditions, 2002 Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. [Medline]. Int J Pediatr Otorhinolaryngol. [Medline]. Oakley GM, Alt JA, Schlosser RJ, Harvey RJ, Orlandi RR. Cochrane Database Syst Rev. Most of the leaks occur in the anterior cranial fossa, the part of the cranium of the skull towards the front. It can also be idiopathic (with no known cause) or due to increased intracranial pressure. Leaks often tend to occur within the first week after the procedure. Cerebrospinal fluid fistula: clinical aspects, techniques of localization, and methods of closure. Very high intracranial pressure is unlikely to cause a CSF leak unless there is existing bone weakness. Br J Neurosurg. Headaches and disturbances in vision tend to arise with the underlying cause, like raised intracranial pressure, and not from the leak itself. Endoscopic procedures are preferable as it less likely to be associated with complications and has a success rate of over 90%. 2016 Nov 1. [Medline]. The most accurate way to diagnose CSF rhinorrhea is to show the presence of beta-2 transferrin in the nasal discharge. Disruption of the barriers between the sinonasal cavity and the anterior and middle cranial fossae is the underlying factor leading to the discharge of CSF into the nasal cavity. Albu S, Florian IS, Bolboaca SD. [Medline]. The sinus cavity may lie just beneath or in front of the bone and the CSF drains into it. It appears that prolonged raised intracranial pressure may be the main cause as it gradually erodes the bone and leads to a leak. In these instances the pressure is only moderately raised therefore not presenting with many other symptoms in the short term. [Medline]. 2005;38:597-611. Sometimes there may be no specific treatment advised apart from conservative measures. Amy Wu, MD, is board-certified in otolaryngology. Am J Rhinol Allergy. However, it is often missed if it does not immediately follow an injury as patients mistaken it for nasal mucus (runny nose). 63 (2):197-201. Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: A systematic review. 2015 Jan-Feb. 29 (1):77-81. Fraser JF, Nyquist GG, Moore N, Anand VK, Schwartz TH. 22(4):718-20. [Medline]. 4:CD004884. Antibiotics may be needed for treating bacterial meningitis. 322713-overview There is no history of surgery or trauma preceding the leak. Anyone who has had repeated episodes of bacterial meningitis should also be evaluated for CSF rhinorrhea. At other times it have weakened during the course of life as a result of certain surgeries. Ratilal BO, Costa J, Pappamikail L, Sampaio C. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Kerr JT, Chu FWK, Bayles SW. Cerebrospinal Fluid Rhinorrhea: Diagnosis and Management. A CSF rhinorrhea can occur whenever there is open communication between the subarachnoid space and other spaces via meningeal disruption. Diseases & Conditions, 2002 Stephen G Batuello, MD Consulting Staff, Colorado ENT Specialists Kevin C Welch, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Rhinologic SocietyDisclosure: Nothing to disclose. This image represents an endoscopic view with a 70-degree telescope through the left frontal recess. A small cribriform plate encephalocele is observed only after removing the middle turbinate. 142:43-7. While CSF rhinorrhea is not a common condition, this diagnosis should be considered in a person who has a chronic runny nose, without other symptoms of allergic rhinitis, that doesn't respond to typical allergy medications. Sellar repair in endoscopic endonasal transsphenoidal surgery: results of 170 cases. Arch Otolaryngol Head Neck Surg. High impact injuries as seen with assault or motor vehicle accidents usually causes immediate CSF leaks. The use of medication is of limited use except in a case of raised intracranial pressure. Cerebrospinal fluid (CSF) is contained within a closed cavity to maintain its volume and therefore perform its functions. PMID: 27303222, Ⓒ 2020 About, Inc. (Dotdash) — All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. The cavity itself is made up by the bony walls of the skull (cranium) and the vertebrae of the spinal cord. 2015 May. (Defect measured approximately 7mm.). Rarely does it occur in the middle or posterior (back) cranial fossa. Nasal congestion It is important to realize that these symptoms also occur in many other, more common, conditions and should be eva… Am J Rhinol Allergy. [Full Text]. Diseases & Conditions, 2002 Lopatin AS, Kapitanov DN, Potapov AA. [Full Text]. [Full Text]. [Medline]. The most obvious symptoms is a clear watery discharge from the nose. Otolaryngol Head Neck Surg. Spontaneous leaks may be idiopathic meaning that it arises due to an unknown cause. James Stankiewicz, MD Professor, Chair, Program Director, Department of Otolaryngology-Head and Neck Surgery, Loyola University Chicago School of Medicine Should I Take Benadryl to Treat a Cold or Allergy? 793582-overview Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine [Medline]. MRI cisternography, and the localization of CSF fistulae. This website also contains material copyrighted by 3rd parties. Diseases & Conditions. [Medline]. 1993 Apr. 1994. Laryngoscope. Dula DJ, Fales W. The 'ring sign': is it a reliable indicator for cerebral spinal fluid?. Lobo BC, Baumanis MM, Nelson RF. CSF rhinorrhea is a condition where cerebrospinal fluid (CSF) leaks through the nose. 1969 Apr. Laryngoscope. 2000 Jul. Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances. Various methods have been used to localize the CSF rhinorrhea, most commonly brain MRI or a nuclear medicine scan with Indium 111. [Medline]. The treatment option depends on a history of preceding injury. 30(4):399-405. 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. The paranasal sinuses lying in the skull have fairly thin walls separating it from the cranial cavity where the brain is housed. Injury to the head, either penetrating or closed injuries, are responsible for majority of the cases of CSF rhinorrhea. 2002 Most commonly, the CSF leak is fixed through nasal endoscopy using a skin or bone graft to plug the hole.. Intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks. [Medline]. People who have developed more than one episode of bacterial meningitis should be evaluated for possible CSF rhinorrhea, as well as an evaluation for primary immunodeficiency by a clinical immunologist. A significant proportion of leaks occur in the region of the cribiform plate of the skull and into the ethmoid sinus. These common causes of a runny nose either last a short period of time, such as with the common cold, or respond to the treatment with allergy medications, such as oral antihistamines, nasal corticosteroid sprays, or nasal anticholinergic sprays. for: Medscape. Read our, Medically reviewed by Jurairat J. Molina, MD, Medically reviewed by Corinne Savides Happel, MD, Medically reviewed by Richard N. Fogoros, MD, Verywell Health uses cookies to provide you with a great user experience. Penetrating and closed-head trauma are responsible for 90% of all cases of CSF leaks. Traumatic CSF rhinorrhea can be classified as immediate or delayed. Traumatic head injury may also cause confusion, disorientation and sometimes stupor as part of a concussion. Ray BS, Bergland RM. Other causes of runny noses include gustatory rhinitis caused by cold weather or eating spicy foods, and vasomotor rhinitis caused by nasal irritants such as strong odors or weather changes. [Medline]. Spontaneous CSF rhinorrhea: prevalence of multiple simultaneous skull base defects. 2002 Dec. 51(6):1365-71; discussion 1371-2. Endoscopic management of spontaneous CSF rhinorrhea with septal graft and middle turbinate rotational flap technique: a review of 31 cases. Ryall RG, Peacock MK, Simpson DA. Endoscopic endonasal CSF rhinorrhea repair in children: Systematic review with meta-analysis. 1990 Dec. 53(12):1072-5. Due to its close proximity to the sinus and nasal cavity, any opening will allow CSF to leak into it and then drain out through the nose. Daniel More, MD, is a board-certified allergist and clinical immunologist. Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck SocietyDisclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;Cliexa;The Physicians Edge;Sync-n-Scale;mCharts
Received income in an amount equal to or greater than $250 from: The Physicians Edge, Cliexa;Proforma;Neosoma
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