Spontaneous Cerebrospinal Fluid Rhinorrhea as the Presenting Symptom of Idiopathic Intracranial Hypertension: A Case Series
Although rare, Cerebrospinal Fluid (CSF) Leakage can result in deadly complications such as meningitis and brain abscess. Previously, primary spontaneous CSF leakage was referred to leakages without any detectable causes. However, it has been found recently that it may be related to abnormal increased intracranial pressure (ICP). Here, we reported demographic, clinical, and therapeutic features in addition to the outcomes of five patients with Idiopathic Intracranial Hypertension (IIH) presented with spontaneous CSF leakage as the initial symptom. Four of our patients were female. The mean age was 38 years old. Rhinorrhea was the first manifestation of the CSF leakage in our patients. Ethmoidal cells were the most common site of leakage. The mean opening pressures (OP) was 31.3 cmH2O. The computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain was normal in all patients except one patient showing fullness in left ethmoidal cells. In all of the patients, cerebral CT cisternography was diagnostic to detect the site of leakage. CSF leak in two patients resolved with medical therapy but CSF diversion procedure was mandatory in other three patients. CSF leakage resolved in all of them. CSF leakage can be the first and only presenting symptom of abnormal increased ICP. The key point in patient treatment is controlling the elevated ICP, even though some patients may need to CSF diversion procedure eventually.
Chaaban, MR. Illing, E. Riley, KO. Woodworth, BA. Spontaneous cerebrospinal fluid leak repair: a five-year prospective evaluation. Laryngoscope. 2014; 124(1): 70-75.
Banks, CA. Palmer, JN. Chiu, AG. O'Malley, BW, J. Woodworth, BA. Kennedy, DW. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg.2009; 140(6): 826-833.
O'Connell, JE. Primary Spontaneous Cerebrospinal Fluid Rhinorrhoea. J Neurol Neurosurg Psychiatry.1964; 27: 241-246.
Yang, Z. Wang, B. Wang, C. Liu, P. Primary spontaneous cerebrospinal fluid rhinorrhea: a symptom of idiopathic intracranial hypertension? J Neurosurg.2011; 115(1): 165-170.
Bandyopadhyay, S. Pseudotumor cerebri. Arch Neurol.2001; 58(10): 1699-1701.
Mokri, B. Intracranial hypertension after treatment of spontaneous cerebrospinal fluid leaks. Mayo Clin Proc.2002; 77(11): 1241-1246.
Rosenfeld, E. Dotan, G. Kimchi, TJ. Kesler, A. Spontaneous cerebrospinal fluid otorrhea and rhinorrhea in idiopathic intracranial hypertension patients. J Neuroophthalmol.2013; 33(2): 113-116.
Deenadayal, DS. Vidyasagar, D. Naveen KM. Sudhakshin, P. Sharath Chandra, SV. Hameed, S. Spontaneous CSF Rhinorrhea Our Experience. Indian J Otolaryngol Head Neck Surg.2013; 65(suppl 2): 271-275.
Matsubara, T. Akutsu, H. Tanaka, S. Yamamoto, T. Ishikawa, E. Matsumura, A. A case of spontaneous cerebrospinal fluid rhinorrhea: Accurate detection of the leak point by magnetic resonance cisternography. Surg Neurol Int.2014; 5: 54.
Perez, MA. Bialer, OY. Bruce, BB. Newman, NJ. Biousse, V. Primary spontaneous cerebrospinal fluid leaks and idiopathic intracranial hypertension. J Neuroophthalmol.2013; 33(4): 330-337.
Choh, NA. Jehangir, M. Suhail, M. Malik, GM. Choh, SA. Spontaneous CSF Rhinorrhoea-A Rare Complication of Pseudotumor Cerebri. JK-Practitioner.2006; 13(3): 144-145.
Clark, D. Bullock, P. Hui, T. Firth, J. Benign intracranial hypertension: a cause of CSF rhinorrhoea. J Neurol Neurosurg Psychiatry.1994; 57(7): 847-849.
Woodworth, BA. Prince, A. Chiu, AG. Cohen, NA. Schlosser, RJ. Bolger, WE. Kennedy, DW. Palmer, JN. Spontaneous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension. Otolaryngol Head Neck Surg.2008; 138(6):715-720.
Menku, A. Tucer, B. Kurtsoy, A. Oktem, S. Gocmez, C. Akdemir, H. Spontaneous Cerebrospinal Fluid Rhinorrhea Associated With Temporal Lobe Meningoencephalocele in the Lateral Sphenoid Sinus in An Adult: Case Report. Turkish Neurosurgery2004; 14(3-4): 76-79.