CSF Rhinorrhoea

CSF RHINORRHEA

• Discharge is clear, watery, appears suddenly in a gush of drops when bending forward (tea pot sign) or straining
•  Uncontrollable and cannot be sniffed back
• No associated sneezing, nasal congestion or lacrimation
• When collected in a test tube and allowed to stand, it remains clear (nasal discharge leaves a sediment)
• Glucose content > 30mg/dI (nasal discharge – < 10 mg/dl)
• β2 transferrin is specific for CSF (absent in nasal discharge)
• In traumatic CSF leak, CSF and blood are mixed – double ring sign or target sign
• CSF Rhinorrhea Occurs in fracture of maxilla in Le Fort type II  and type III. (as cribriform plate is injured here) and also in nasal fracture class Ill

 Localization of CSF leak

Intrathecal injection of a dye or a radioisotope and placing pledges of cotton in the olfactory slit, middle meatus, Sphenoethmoidal recess and near the Eustachian tube and examine the pledges for radioactivity

• Olfactory slit – cribriform plate (most common site)
• Middle meatus – frontal or ethmoidal sinus
• Sphenoethmoidal recess – sphenoid sinus
• Eustachian tube – temporal bone

Management

• Immediate Management – Antibiotics and Observation
•  Persistent Case Treated surgically by nasal endoscopy or intracranial route

Exam Question

• Discharge is clear, watery, appears suddenly in a gush of drops when bending forward (tea pot sign) or straining
• Uncontrollable and cannot be sniffed back
• Glucose content > 30mg/dI (nasal discharge – < 10 mg/dl)
• β2 transferrin is specific for CSF (absent in nasal discharge)
• Olfactory slit – cribriform plate of Ethmoid Bone (most common site)In traumatic CSF leak, CSF and blood are mixed – double ring sign or target sign
• Immediate Management – Antibiotics and Observation
•  Persistent Case Treated surgically by nasal endoscopy or intracranial route
• CSF Rhinorrhea Occurs in fracture of maxilla in Le Fort type II  and type III. (as cribriform plate is injured here) and also in nasal fracture class Ill