WHAT IS CSF RHINORRHEA?
CSF ( Cerebrospinal fluid ) is a colourless , watery liquid found in and around your brain and the spinal cord which helps to cushion them from injury (protection) and also provides nutrients. CSF Rhinrrhoea is the leakage of this fluid into your nose . If the CSF leaks into the ear, we call it CSF otorrhea.
WHAT CAUSES CSF RHINORRHEA?
What causes this brain fluid to run down into/ from your nose?
1. Trauma or injury to the head or nose
2. Surgery ( nose surgery or brain surgery)
3. Congenital – birth defects
There is a tear in the membranes surrounding the brain that hold this fluid and hence it leaks into your nose which leads to a watery, clear nasal discharge.
4. Spontaneous CSF leak i.e. in the absence of an obvious cause (Primary Intracranial Hypertention or secondary to tumors may cause a spontaneous CSF leak)
SYMPTOMS OF CSF RHINORRHEA:
1. Clear water running from one nostril, especially when you bend your head forwards.
2. Headache
3. If due to CSF Rhinorrhea , infection spreads from the nose to your brain, it may lead to a devastating condition called Meningitis (symptoms of which are headache, fever and neck stiffness)
It is important therefore that you visit your ENT specialist near you immediately if you exhibit any of these symptoms.
HOW DO YOU DIFFERENTIATE CSF RHINORRHEA FROM RHINITIS?
CSF Rhinorrhea is not a common entity. Clear water running from your nose need not always alarm you as clear discharge from the nose is also a sign of rhinitis, especially allergic rhinitis. In case of Allergic Rhinitis , however, the clear , watery discharge from the nose is generally accompanied with bouts of sneezing and sometimes even nose block. Other types of Rhinitis like Vasomotor Rhinitis or even a Viral cold may be the cause of clear, watery nasal discharge.
HOW IS CSF LEAK DIAGNOSED?
Once your ENT doctor suspects the discharge from your nose as a CSF leak, he/she may order further investigations like a Beta 2 transferrin test of the nasal discharge. Here the fluid is collected with aseptic precautions and sent to the laboratory to check for Beta 2 transferrin which is a protein only found in your brain fluid or CSF.
Once the CSF is confirmed then a CT scan may need to be done to determine the site of leak.
Generally we order for a CT cisternography which is the diagnostic modality to detect the site of CSF leak. A dye is injected and the patient is made to lie down in a particular position (Trendelenburg position – Head down and feet elevated) followed by CT imaging.
Additional investigations like evaluation by your Opthalmologist to rule out raised Intracranial pressure or even a Lumbar puncture may be required.
HOW IS CSF LEAK TREATED?
In case of the above mentioned symptoms, you need to consult the best ENT specialist near you immediately. After thorough examination and investigations, if it is revealed that the leak is minor then there is a chance that you will be asked to wait for it to resolve spontaneously with conservative management. At such times it is mandatory that you avoid all kinds of activities that involve straining like coughing, sneezing, straining at stools or lifting heavy weights.
If the leak fails to heal spontaneously, then surgical treatment to repair the leak will be necessary. Now surgery for CSF leak repair can be done via two approaches – one is a neurosurgical approach through the skull and the other is an endoscopic approach via the Nose by ENT surgeon / skull base surgeon. Please consult the best ENT surgeon near you for repair of CSF leak if you are diagnosed with this problem.
Post the surgical repair of CSF Rhinorrhea, you may be required to stay in the hospital for 3 to 4 days for Intravenous antibiotics and observation. The repair site takes around 4 to 6 weeks to heal completely and as mentioned above , the patient has to avoid all kinds of straining activities like lifting heavy weights, coughing, sneezing etc.
Leaving a CSF Rhinorrhea untreated can be dangerous. If not addressed, it may lead to lifethreatening complications like Meningitis, seizures or even stroke. Therefore do not ignore that watery clear discharge from your nose. Visit the one of the best ENT specialist in Mumbai for a more specific and accurate diagnosis of your Ear Nose Throat problems.
