Spontaneous CSF fistula: An Important Diagnosis to Omit

Introduction Cerebrospinal fluid (CSF) rhinorrhea is an infrequent reason of serous nasal discharge. Detection of CSF in nasal secretion indicates presence of abnormal connection between nasal cavity and subarachnoid space. Delay in diagnosis CSF fistula places the patient at risk of developing meningitis. This clinical situation usually emerges subsequent to head traumas. Spontaneous CSF fistula is a rare clinical entity.

Case Report The 42-year-old obese male patient without any complaints of fever consulted to a general practitioner one week after his complaint of transparent discharge from right nose started. He has been put on medication for allergic rhinitis and sinusitis. The patient without any improvement at his symptoms during 2 months was also diagnosed with allergic rhinitis by an otolaryngologist. Due to persistent rhinorrhea he was put on antibiotic therapy for chronic sinusitis. Meanwhile he had visited the emergency service for fever complaint 3 times. With his persistent complaints the patient was consulted to Ankara University ENT outpatient clinic after 10 days of hospitalization for sinusitis research. Paranasal sinus CT showed soft tissue density in the posterior ethmoids. CSF rhinorrhea was suspected and beta-2-transferrin test is performed. MR cisternography, indicated fluid density at suspected level in continuity with the subarachnoid space. With these examinations spontaneous CSF rhinorrhea was diagnosed and an endoscopic endonasal dura repair was performed.

Conclusion For the differential diagnosis of unilateral rhinorrhea, spontaneous CSF fistula should always be kept in mind. During the diagnostic work up of patients utilizing reliable test such as beta-2-transferrin test can be life saving as it would protect them from meningitis.

Publication History

Article published online:
10 June 2020