Spontaneous Cerebro-Spinal Fluid Rhinorrhoea Caused by Sustained Intracranial Hypertension

Abstract

Cerebrospinal Fluid (CSF) leakage results from a defect in the skull base, which communicates the subarachnoid space with the nasal cavity. The most common cause of CSF leakage is traumatic, and non-traumatic causes are less common. This case report illustrates a case of a woman who presented to the emergency department with clear fluid pouring from her nose for three weeks with a fever. The patient had pneumococcal meningitis and Idiopathic Intracranial Hypertension (ICH) seven years ago. Computed Tomography (CT) sinuses showed the defect seen on the right side of the cribriform plate, and the Magnetic Resonant Imaging (MRI) confirmed the CSF leakage. The CSF leakage was diagnosed by positive B transferrin. This case highlights a rare condition that needs early detection and treatment to prevent complications such as ascending meningitis.

Ventriculoperitoneal Shunt Alone for Spontaneous Cerebrospinal Fluid Rhinorrhea as a Presenting Symptom of Hemi-hydranencephaly

“…It is generally believed that ICP in patients with CSF rhinorrhea may be normal because of CSF loss. 6 In this case, the ICP obtained through a lumbar puncture was in the upper limit of the normal range, but it is likely that the ICP was high before the CSF leak.…”

“…Spontaneous CSF rhinorrhoea is rare and associated with elevated intracranial pressure (ICP), pregnancy, elevated body mass index, etc. It is generally believed that ICP in patients with CSF rhinorrhea may be normal because of CSF loss 6 . In this case, the ICP obtained through a lumbar puncture was in the upper limit of the normal range, but it is likely that the ICP was high before the CSF leak.…”

Endoscopic Endonasal Anterior Skull Base Meningoencephalocele and Cerebrospinal Fluid Leak Repair: Our Intraoperative and Postoperative Protocol and Long-term Outcomes

“…3,7,8,24 Younis et al describe evidence that prolonged intracranial hypertension can cause skull base defects and subsequent CSF leaks. 28 Lobo et al discuss that gender, obesity, and elevated intracranial pressure can result in CSF leaks 25 ; Chaaban et al prospectively investigated the outcomes of sCSF leaks in 46 patients with 56 sCSF leaks and provided evidence that elevated intracranial pressure subsequently caused most CSF leaks. 29 Teachey et al's case-series and systematic review of 679 patients investigated how ICP and IIH interventions impact recurrence rates; primary endoscopic repair success rates were significantly improved with active management for elevated ICP and IIH compared with those without intervention.…”