Spontaneous cerebrospinal fluid leak of the sphenoid sinus mimicking allergic rhinitis, and managed successfully by a ventriculoperitoneal shunt: a case report

Darouassi, Youssef; Touati, Mohamed; Chihani, Mehdi; Akhaddar, Ali; Ammar, Haddou; Bouaity, Brahim

doi:10.1186/s13256-016-1107-0

Cited by 16 publications

(14 citation statements)

References 19 publications

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“…However, CSF rhinorrhea occurred again after lumbar drainage, probably because of the persistently high ICP. It was already reported that a patient with spontaneous CSF rhinorrhea was managed successfully by a VPS alone (Darouassi et al, 2016). Even if the endoscopic repair for the present case had not been carried out yet, placement of a permanent CSF drain, in the form of a VPS or LPS, could be considered in this case.…”

Section: Discussionmentioning

confidence: 85%

Successful Treatment of Spontaneous Cerebrospinal Fluid Rhinorrhea With Endoscopic Third Ventriculostomy and Lumboperitoneal Shunt: A Case Report

et al. 2020

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Spontaneous cerebrospinal fluid (CSF) rhinorrhea represents an important clinical entity that is being observed with increasing prevalence, ranging from 14 to 55%. Spontaneous CSF rhinorrhea is associated with elevated intracranial pressure (ICP), which is rarely stopped without surgical intervention. Endoscopic endonasal repair is typically warranted for CSF rhinorrhea. However, the recurrence rate of CSF leaks after the endoscopic endonasal repair of skull base defects due to ICP is usually high. We describe a 25-year-old man without a history of head injury, tumor, or obesity. The onset of his symptoms occurred in 1 week in the form of a persistent clear left nostril rhinorrhea. Computed tomography (CT) and magnetic resonance images (MRI) showed signs of CSF in the left sphenoidal sinus, meningocele in the left frontal sinus, empty sella, hydrocephalus, and Chiari I malformation (CIM). Cine-MRI revealed the flow of CSF was obstructed at the aqueduct and the outlet of the fourth ventricle. Endoscopic third ventriculostomy (ETV) was performed for the patient with obstructive hydrocephalus. Post-operative CSF pressure measurement demonstrated elevated ICP. The patient still had case of CSF rhinorrhea, and subsequently underwent lumboperitoneal shunt (LPS) for treatment of ICP. The patient showed a prompt resolution of CSF leak. Ten months later, the patient showed a significant improvement in terms of his herniated tonsil and cessation of CSF rhinorrhea.

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Section: Discussionmentioning

confidence: 85%

Successful Treatment of Spontaneous Cerebrospinal Fluid Rhinorrhea With Endoscopic Third Ventriculostomy and Lumboperitoneal Shunt: A Case Report

et al. 2020

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“…Indeed, assuming that most spontaneous skull base CSF leak patients have underlying IIH, and that a CSF leak is a sign of chronic poorly controlled IIH, 3–5 one might hypothesize that the leak acts as a “pressure release valve,” providing relief of symptoms and signs of raised ICP, precluding or delaying the presentation of IIH. 22 Papilledema has been uncommonly reported at presentation in CSF leak patients, with a pooled prevalence of only approximately 5%, 3 , 6 , 23–26 but preoperative signs suggestive of raised ICP were underestimated in these studies, as these also include sixth nerve palsy and peripapillary changes of resolved papilledema. None of the previous studies provided details regarding a previous history of IIH or the presence of resolved signs of intracranial hypertension.…”

Section: Discussionmentioning

confidence: 89%

Spontaneous Skull Base Cerebrospinal Fluid Leaks and Their Relationship to Idiopathic Intracranial Hypertension

Bidot

Levy

Saindane

et al. 2020

Am J Rhinol�Allergy

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Background The association between spontaneous skull base cerebrospinal fluid (CSF) leaks and idiopathic intracranial hypertension (IIH) has been suggested, but its significance remains unclear. Objective To estimate the prevalence of IIH in spontaneous skull base CSF leak patients. Methods Systematic collection of demographics, neuro-ophthalmic and magnetic resonance imaging evaluation of spontaneous skull base CSF leak patients seen pre- and post-leak repair in one neuro-ophthalmology service. Patients with preexisting IIH were diagnosed with definite IIH if adequate documentation was provided; otherwise, they were categorized with presumed IIH. Classic radiographic signs of intracranial hypertension and bilateral transverse venous sinus stenosis were recorded. Results Thirty six patients were included (age [interquartile range]: 50 [45;54] years; 94% women; body mass index: 36.8 [30.5;39.9] kg/m2), among whom six (16.7%, [95% confidence interval, CI]: [6.4;32.8]) had a preexisting diagnosis of definite or presumed IIH. Of the remaining 30 patients, four (13.3%, 95%CI: [3.8;30.7]) had optic nerve head changes suggesting previously undiagnosed IIH, while one was newly diagnosed with definite IIH at initial consultation. One out of 29 patients with normal findings of the optic nerve head at presentation developed new onset papilledema following surgery (3.4%, 95%CI: [0.1;17.8]) and was ultimately diagnosed with definite IIH. Overall, the prevalence of definite IIH was 19.4% (95%CI: [8.2;36.0]). Conclusion Striking demographic overlap exists between IIH patients and those with spontaneous CSF leak. Definite IIH was present in approximately 20% of our patients. However, its true prevalence is likely higher than identified by using classic criteria. We therefore hypothesize that an active CSF leak serves as an auto-diversion for CSF, thereby “treating” the intracranial hypertension and eliminating characteristic signs and symptoms at initial presentation.

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“…[ 4 , 15 ] Constipation is reported in more than half of the patients with PAF and is frequently an early symptom of the disease. [ 5 ] The repetitive closed glottis efforts following chronic constipation leads to sustained intra-abdominal and intra-thoracic increased pressure and could predispose to an intermittent or permanent ICH with weakness of the dura mater and CSF leaks.…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal fluid fistula in a patient with chronic constipation related to an autonomic dysfunction and revealed by bacterial meningitis – A case report

Abboud¹,

Kharbouch

Arkha

et al. 2020

Surgical Neurology International

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Background: Cerebrospinal fluid (CSF) fistula represents a rare neurosurgical entity that can be defined as a communication between the subarachnoid space and nasal fossa or less commonly the ear cavity. It can be spontaneous without an evident etiology or secondary following a skull base surgery or trauma. The early diagnosis of spontaneous forms remains a challenge as clinical signs (e.g., unilateral rhinorrhea) can be absent or neglected by patients and can result in meningitis. Case Description: Here, we report the case of a 31-year-old man with chronic constipation complicated by chronic intracranial hypertension, and resulting in rhinorrhea with bacterial meningitis. The etiological assessment of chronic constipation retained an autonomic dysfunction with sympathetic hyperactivity (e.g., pure autonomic failure) as an underlying cause. Beta-2 transferrin testing associated with cerebral magnetic resonance imaging and computed tomography scan confirmed the diagnosis and localization of the fistula at the cribriform plate. The patient underwent an endoscopic endonasal approach with a repair of fistula. He presented with recurrent rhinorrhea 17 months later which required a surgical revision along with CSF diversion with a ventriculoperitoneal shunt. Conclusion: Although rare, autonomic dysfunction can result in chronic constipation in young patients, with intermittent or permanent intracranial hypertension, leading to CSF leaks. The early identification and treatment of the underlying etiology may prevent severe complications and improve the management and outcome of CSF fistula patients.

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Spontaneous cerebrospinal fluid leak of the sphenoid sinus mimicking allergic rhinitis, and managed successfully by a ventriculoperitoneal shunt: a case report

Cited by 16 publications

References 19 publications

Successful Treatment of Spontaneous Cerebrospinal Fluid Rhinorrhea With Endoscopic Third Ventriculostomy and Lumboperitoneal Shunt: A Case Report

Successful Treatment of Spontaneous Cerebrospinal Fluid Rhinorrhea With Endoscopic Third Ventriculostomy and Lumboperitoneal Shunt: A Case Report

Spontaneous Skull Base Cerebrospinal Fluid Leaks and Their Relationship to Idiopathic Intracranial Hypertension

Cerebrospinal fluid fistula in a patient with chronic constipation related to an autonomic dysfunction and revealed by bacterial meningitis – A case report

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