This document discusses CSF rhinorrhoea, which is a leakage of cerebrospinal fluid (CSF) from the nose. It can originate from defects in the cribriform plate or sinuses. Causes include traumatic injuries from surgery or accidents, inflammation, tumors eroding the skull, and congenital defects. Symptoms include a watery nasal discharge, headaches, and anosmia. Diagnosis involves tests of the nasal fluid and imaging scans. Treatment options range from conservative measures like bed rest to surgical repair of the defect. Complications can include meningitis, pressure on the brain, and chronic headaches if left untreated.

1. CSF
rhinorrhoea

2. rhino = nose
rrhoea = leakage
So :
CSF rhinorhoea =
leakage of csf from nose
Def:

3. Origin :
• Roof of the nose “cribriform plate”
• Sinuses “frontal ,ethmoid,sphenoid”
• Middle ear “CSF otorhinorrhoea through
the ET”

4. Causes :
causes of CSF rhinorrhoea CSF leaks occur
spontaneously and the cause is unknown,
other causes lead to CSF leakage
1-traumatic :
*surgical : endoscopic sinus surgery&
removal of tumor from roof of nose
*accidental :fracture base of ant cranial
fossa

5. 2-inflammatory: syphiliticosteitis or osteomylitis

6. 3-neoplastic: tumor eroding roof of nose
4-congenital: defect in cribriform plate

7. 5-high-pressure hydrocephalus: an
abnormal accumulation of cerebrospinal fluid,
also may be at an increased risk of developing
leaks

8. Clinical picture :
Symptoms :
1-unilateral watery nasal discharge :-
• Spontaneous onset
•Clear
•Colorless
•Salty taste
•Doesn’t stiffen the handkerchief
•Increase with coughing straining
and leaning forwad

9. 2- Headache:
Positional headache
high csf pressure if there is brain tumor
low Csf pressure caused by leackage
3- anosmia
May be noted which suggest
cribriform plate fracture with
olfactory tract trauma

10. other symptoms:
•Changes in vision Stiffness
•nausea and vomiting
•Hearing loss “ otorrhea”
Signs:
Reservoir sign one of the diagnostic sign by
endoscopy
The Reservoir sign:
is a gush of fluid through the nose occur when
sitting up suddenly after a period of recumbency
indicating drainage of csf pooled in the nasopharynx

11. :
Complications
1- meningitis :
It’s inflammation of the meninges
It’s the commonest & the most
serious complication of csf rhinorrhea
(it’s a complication of un repaired fistula opened
into the nose which is highly infectious area )
With any blowing many organisms are sucked
into meninges. It is fatal if not treated .

12. 2-intra cranial aereocele:
during blowing or cough air is sucked into
brain forming cele causing pressure
so increase intracranial tension
3-chronic headache:
2 types or causes
low csf pressure because csf
rhinorrheal leakage
high csf pressure may be due to cancer

13. 4-intracranial
hematomas
5-frontal lope abscesses
6-smell disorders
7-recurrence

14. Investigation :
1-Biochemical analysis of discharge:
CSF is characterized by:
Clear
Colorless
contain no mucus
Contain sugar more than 30 %
Contain B2 transferrin which is diagnostic
Reduce fehling’s solution

15. 2-CT with intrathecal metrizamid
It can detect the
site of leakage
3-Intra-thecal dye (flourescine)
With endoscopic examination
of the nasal cavity
to see the defec

16. Treatment :
Conservative:
bed rest in semi sitting postion with
the head up
avoid coughing &straining
avoid blowing if nose
avoid nasal medications
prophylactic antibiotics.

17. Surgical:
covering the defect by graft or
flap if conversation failed
it can be done externally or
recently endoscopic

18. :
Under supervision
Ibrahim Rizk Ahmed Alnhaas
:
Made by
Areej Mohamed Sara Hassan
Nurhan Ahmed Omnia Ahmed
Amira Mohamed Asmaa
Omar (Round 2)