Runny nose is a common occurrence which is usually caused by sinus infections, allergies, or common cold. However, on rare occasions it can indicate a much more serious underlying condition - a leak of Cerebrospinal Fluid (CSF) from the brain. Since CSF is essential for maintaining integrity of the brain and spinal cord, its leakage poses serious health risks. It comes with symptoms like excruciating headaches, infections, and even nervous system damage. It is critical to understand the origins of a CSF leak and to identify its symptoms in order to avoid further complications.
We use the term "CSF Rhinorrhea" to describe discharge of CSF through the nose. It manifests as sporadic, frequently positional discharge of clear fluid from nose. Sometimes traces of blood can be found in it. A list of medical causes behind CSF leaks that need immediate attention are:
Trauma: The dura mater, the membrane that encloses brain and the CSF, can be harmed by surgical procedures or head injuries
Spontaneous leaks: Congenital abnormalities of bone or Meninges or elevated intracranial pressure may be the cause of CSF leaks that happen for no apparent reason at times
Medical conditions: The emergence of CSF leaks may be facilitated by ailments that increase CSF pressure or make the meninges prone to tear
A range of symptoms, some of which are easily confused with more prevalent illnesses, can be present with CSF leaks. Important clues suggesting that a runny nose could represent cerebral fluid include:
Clear, watery drainage: CSF is usually clear and watery, in contrast to mucus from allergies or colds
Unilateral nasal discharge: Usually, one nostril discharges the fluid
Position-dependent symptoms: Bending forward or putting strain on oneself may make symptoms worse
Headache: A persistent headache, especially one that goes away when you lie down, may indicate a CSF leak
Tinnitus: A CSF leak may be accompanied by ringing in the ears
Visual disturbances: You may experience double or blurry vision and also cognitive disturbances or difficulty in balancing
Diagnosis of CSF leak involves combination of clinical assessment and diagnostic tests. Laboratory investigations include:The beta-2 transferrin or Beta trace protein test: This test looks for a protein specific to CSF in nasal secretions. This test is highly sensitive and specific for CSF leaks
Imaging studies: MRI or CT scans can be used to determine the location of leaks and determine the degree of damage. An MRI/CT Cisternogram aids in pinpointing the leak's location
Intrathecal Fluorescein Dye: In order to monitor the CSF's flow and identify the leak, a fluorescent dye is injected into the body
The degree and underlying cause of CSF leaks determine the course of treatment: Conservative management: The leak may occasionally repair itself with bed rest, increased fluid intake, head elevation, caffeine intake, stool softeners, prevent blowing or sneezing out of the nose, and avoiding activities that raise intracranial pressure
Epidural blood patch: In order to stop the leak, the patient's blood is injected into the epidural area
Surgical repair: To halt the leak and restore the injured dura mater, surgery may be required in more serious cases. Among the surgical techniques are trans-nasal endoscopic approach, Osteoplastic Flap approach, and external Ethmoidectomy.
In summary, most often runny noses are mostly benign, it's important to know when they could indicate a CSF leak. For the purpose of avoiding problems and ensuring a quick recovery, early diagnosis and suitable treatment are essential. It is imperative that one seeks early medical attention to rule out a CSF leak and obtain proper care if you have a persistent, clear nasal discharge along with other symptoms.
(Author: Dr Pawan Ojha, Director-Neurology, Fortis Hiranandani Hospital, Navi Mumbai)
