Cerebrospinal fluid rhinorrhea is when cerebrospinal fluid leaks from the brain through the nose due to a tear in the membranes and skull. It can be caused by head trauma, tumors, birth defects, or high pressure in the skull. Symptoms include a clear, watery, and salty nasal discharge. It can lead to brain infection or meningitis and may require surgery.
Cerebrospinal fluid rhinorrhea occurs when the cerebrospinal fluid, or cerebrospinal fluid, that bathes the brain leaks through the surrounding membranes and bones and emerges through the nose. Anything that causes a tear in the dura mater and arachnoid, the membranes that enclose the brain and cerebrospinal fluid, and also punches a hole in the skull, could lead to the formation of a drainage channel between the brain and the nose. The most common cause is head trauma, either from an accident or acquired during surgery. Tumors and birth defects can also lead to CSF draining through the nose, or they can occur for no obvious reason. Rhinorrhoea is a British spelling and in the US the word is more typically rhinorrhea.
A patient with CSF rhinorrhea may not be aware of the condition, or may exhibit symptoms of a clear, typically one-sided nasal discharge that is watery and may have a salty taste. In about 90% of cases, the problem is caused by a head injury. In general, CSF rhinorrhea can be divided into two main categories with different causes, known as traumatic and atraumatic. Traumatic cases are those that result from an injury and atraumatic ones are due to other causes.
The traumatic causes of CSF rhinorrhea can be further divided into those that occur as a result of surgical procedures and those that are due to accidental injury. Accidental injury is more common and could consist of a blow to the head with a blunt object or what is known as a penetrating injury, where something pierces the skull. Sometimes a CSF leak is noticed immediately, within the first 48 hours, and other times there may be a delay of up to three months before the condition manifests itself. Nonsurgical injuries, such as automobile accidents, are more likely to lead to an immediate CSF leak, while a leak after surgery may take longer to develop. The types of surgery that are typically associated with CSF rhinorrhea are neurosurgical procedures and sinus operations.
Atraumatic causes of CSF rhinorrhea include birth defects, in which the skull and the membranes surrounding the brain don’t form properly. Aggressive tumors can grow through the skull bone and destroy the dura mater membrane, allowing cerebrospinal fluid to leak from the subarachnoid space around the brain. Sometimes CSF rhinorrhea appears to arise spontaneously, but it is usually the result of increased pressure within the skull. This high pressure eventually weakens the bone and causes a hole, allowing membranes and sometimes brain tissue to pass through the hernia.
CSF rhinorrhea is associated with a serious risk of brain infection or meningitis, which can be fatal. Some cases can be treated with a combination of bed rest and medication. Others require surgery to repair the underlying defects.
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