The rhinorrhea is the expulsion of cerebrospinal fluid through the nose. It can occur from a post-traumatic event such as a fracture or spontaneously. It is a rare and very serious condition that can lead to death from complications such as infections in the nervous system; including meningitis and pus abscesses in the brain.
The result of this communication between the central nervous system and the nasal cavity can cause a multitude of infectious complications of great morbidity and catastrophic effects on the patient..
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The main cause of rhinorrhea, also known as cerebrospinal fluid rhinorrhea, is the breakdown of the barriers between the sinonasal cavity and the middle cranial fossa and the anterior cranial fossa. This leads to the discharge of cerebrospinal fluid into the nasal cavity..
Cerebrospinal fluid leaks are generally of traumatic, iatrogenic cause - caused as an unwanted side effect of some treatment or surgical procedure - or even due to idiopathic and spontaneous causes.
Among the traumatic causes are penetrating and blunt facial wounds, iatrogenic causes such as those caused by neurosurgery or otorhinolaryngological processes destined to approximate a neoplastic disease (cancer) found in the area.
Functional sinus surgery can also cause these cerebrospinal fluid leaks inadvertently..
On the other hand, among the causes of a spontaneous type appear the secondary effects of a significant increase in intracranial pressure. This appears especially in patients with idiopathic intracranial hypertension..
Some congenital defects of the base of the skull and also the presence of certain tumors can cause rhinorrhea in the patient.
90% of patients with rhinorrhea have suffered a blunt or penetrating trauma to the head. The rhinorrhea that precedes a traumatic injury is classified immediately (within the next 48 hours), or with delay.
The majority of patients who have spillage of cerebrospinal fluid due to a traumatic event, such as a car accident, present this symptom immediately..
The rest of the patients (95%) who do not present rhinorrhea at the time of the accident, tend to manifest it within 3 months of the trauma suffered..
On the other hand, iatrogenic rhinorrhea occurs during surgeries performed at the base of the skull. Any surgical manipulation in this area can result in spinal fluid leakage..
Damage can range from a crack in the bone structure to a large tear of more than 1 centimeter that affects the dura and possibly also the parenchyma of the brain..
Any otorhinolaryngological procedure and also nasal surgeries can cause damage to the base of the skull and lead to a rhinorrhea. In the case of endoscopic sinus surgery, the most common rupture is the lateral lamella of the cribriform plate.
In the case of tumors, it is usually always malignant neoplasms such as an inverted papilloma that erode the bones of the anterior fossa of the skull. It is very rare for a benign tumor to cause rhinorrhea.
If the tumor itself does not cause the bones to fracture, a spillage of cerebrospinal fluid will immediately occur when it is removed. However, medical teams are ready to repair the injury at the right time..
There are also cases of spontaneous rhinorrhea, with no previous history of the patient. These events are usually idiopathic. However, the latest evidence has shown a relationship between cerebrospinal fluid effusions and elevated intracranial pressure. Obstructive night apnea is one of the causes of this increased intracranial pressure.
The spillage of cerebrospinal fluid through the nasal cavity can be verified by collecting nasal fluid. This check can be done based on two methods.
The first is the oldest and consists of identifying the presence of glucose. The second is to find out if there are much more specific components such as beta 2 transferrin, a protein found in cerebrospinal fluid..
In addition to this, a complete physical examination of the head and neck and an endoscopy of the nasal cavity and adjacent regions are performed. An MRI is also done, where any brain abnormalities can be examined..
Another more specific exam that is performed is a cisternography, which allows to identify the place where the spillage of cerebrospinal fluid occurs precisely. Contrast that is injected into the dura is used.
One of the symptoms of rhinorrhea is a headache, which worsens with sitting up and improves with rest. It can be associated with tenderness, nausea, and stiff neck.
Contrary to what you might think, spillage of cerebrospinal fluid through the nose and ears is not a common symptom of this condition..
When rhinorrhea leads to infection, patients have symptoms such as fever, chills, or changes in mental status. At this time, the clinical picture is considered an emergency and should be treated with antibiotics..
Rhinorrhea is a serious condition that must be treated immediately, to avoid complications such as meningitis, brain abscess (pus in the brain) and other infectious diseases in the central nervous system..
In case of rhinorrhea, the recommended treatment is to repair the crack through surgery..
In some cases it can resolve spontaneously. Complete bed rest is recommended for a few days, increasing fluid intake, especially caffeinated drinks, which can help stop the stroke or make it less intense. In addition, caffeine can alleviate the intense headache that patients present.
This migraine is treated with pain relievers and fluids. Lumbar punctures are also performed to remove cerebrospinal fluid..
Another option is to put a "blood patch", that is, a small blood clot where the rupture is located to seal it and thus stop the rhinorrhea. If the rhinorrhea does not stop after 5 or 7 days, repair surgery is the alternative.
The prognosis of rhinorrhea depends on the case and the patient. If infections do not occur, most cases resolve spontaneously without sequelae for the person..
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