Spontaneous rhinorrhea and idiopathic intracranial hypertension: a complex and challenging association

Abstract

Introduction. Spontaneous CSF leak is a known complication of idiopathic intracranial hypertension (IIH). Patients with CSF rhinorrhea present a unique challenge within the IIH population, as the occurrence of a leak can mask the typical IIH symptoms and signs, complicating the diagnosis. Treatment of leaks in this population can also be challenging, with the risk of rhinorrhea recurrence if intracranial hypertension is not adequately treated.Objective. The aim of this narrative review was to examine current literature on the association between spontaneous CSF rhinorrhea leaks and IIH, focusing on key clinical features, diagnostic approaches, management strategies, and outcomes. Material and methods. A literature search was executed using the PubMed and Scopus databases. The search was confined to articles published between January 1985 and August 2023; extracted data was then analysed to form the foundation of the narrative review. Results. This search yielded 26 articles, comprising 943 patients. Average age was 46.8 ± 6.5 years, and average body mass index was 35.8 ± 4.8. Most of the patients were female (74.33%). Presenting symptoms were rhinorrhea, headaches and meningitis. The most common imaging findings were empty sella and encephalocele. The standard treatment approach was endoscopic endonasal approach for correction of CSF rhinorrhea leak, and shunt placement was also performed in 128 (13%) patients. Recurrences were observed in 10% of cases. Conclusions.The complex relationship between spontaneous CSF leaks and IIH is a challenge that benefits from multidisciplinary evaluation and management for successful treatment. Treatments such as endoscopic repair, acetazolamide, and VP/ /LP shunts reduce complications and recurrence. Personalised plans addressing elevated intracranial pressure are crucial for successful outcomes.

Overlapping challenges of treating cerebrospinal fluid dynamic disorders

“…Given that these patients often require multiple diagnostic interventions, such a comprehensive team strategy becomes essential. Moreover, the extended period preceding leak recurrence shown by our authors, c.20.5 ± 13 months, highlights the need for longitudinal team follow-up [5]. www.journals.viamedica.pl/neurologia_neurochirurgia_polska Olga P. Fermo, Overlapping challenges of treating cerebrospinal fluid dynamic disorders In contrast to the relatively few patients with cranial leaks experiencing headache, as shown by Macedo et al [5], headache is overwhelmingly the most common presenting symptom of a spontaneous spinal CSF leak, present in 98.6% of patients [8].…”

“…Moreover, the extended period preceding leak recurrence shown by our authors, c.20.5 ± 13 months, highlights the need for longitudinal team follow-up [5]. www.journals.viamedica.pl/neurologia_neurochirurgia_polska Olga P. Fermo, Overlapping challenges of treating cerebrospinal fluid dynamic disorders In contrast to the relatively few patients with cranial leaks experiencing headache, as shown by Macedo et al [5], headache is overwhelmingly the most common presenting symptom of a spontaneous spinal CSF leak, present in 98.6% of patients [8]. Spontaneous intracranial hypotension from a spinal CSF leak can be misdiagnosed as a Chiari type 1 malformation when subtle imaging findings are overlooked, a problem that Boczarska-Jedynak and Stompel set out to rectify in this issue [9].…”

“…To further complicate matters, spontaneous intracranial hypotension from a spinal CSF leak may be caused by underlying intracranial hypertension [10] akin to the cranial leaks described in this issue by Macedo et al [5], and the treatment of spontaneous intracranial hypotension can result in intracranial hypertension [11]. These problems are illustrated in the case in Figure 2.…”

“…Macedo et al present a narrative review of the association between PTCS and spontaneous CSF rhinorrhea [5]. Their extensive literature review, encompassing a total of 943 patients, focuses on the commonly identified patient characteristics, clinical presentation, imaging findings and management of spontaneous skull-based CSF leaks caused by intracranial hypertension.…”