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CSF leak is a phenomenon in which cerebrospinal fluid flows from the inside of the skull to the outside through the ear or nostril. Cerebrospinal fluid leak after trauma is a common complication. CSF leakage through the nose can cause complications such as rhinitis, nasal infection, encephalitis, and meningitis.1. What is a CSF leak through the nose?
Cerebrospinal fluid is a fluid that flows in the ventricles (cavities or spaces) and around the surfaces of the brain and spinal cord. Cerebrospinal fluid acts as a buffer for the brain and spinal cord from injury, and serves as a system for delivering nutrients and removing waste to the brain. Cerebrospinal fluid is produced continuously in areas of the brain called the ventricles and is absorbed by the blood.
CSF leak is a condition that occurs when cerebrospinal fluid leaks through a defect in the dura mater or skull and drains out through the nose or ears. A nasal CSF leak can also result from a hole or tear in the dura, the outermost layer of the meninges. The cause of the hole or tear can be head trauma and brain or sinus surgery. Post-traumatic cerebrospinal fluid leak is a condition that can occur after a traumatic brain injury that causes a skull fracture. The loss of cerebrospinal fluid causes the previously cushioned brain to sag inside the skull, leading to headaches.
CSF leaks through the nose can also occur spontaneously for unknown reasons.
2. Symptoms of cerebrospinal fluid leak through the nose
Symptoms of a CSF leak may include:
Water coming out of the nose or ears Headache, feeling worse when sitting up or standing up and relieved when lying down; may occur gradually or suddenly Vision changes (blurred vision, double vision, visual field changes) Hearing changes/tinnitus Sensitivity to light Sensitivity to sound Balance problems Stiffness and pain neck Nausea and vomiting Pain between shoulder blades, arm pain Meningitis In addition, symptoms indicative of a CSF leak through the nose include:
Clear nasal discharge usually from only one side of the nose when tilted head forward Salty or metallic taste in the mouth Fluid running down the back of the throat Loss of smell MORE: Endotracheal anesthesia endoscopic surgery for cerebrospinal fluid leakage
Rò dịch não tủy qua đường mũi với một số triệu chứng dễ dàng nhận biết
3. Treatment of cerebrospinal fluid leakage through the nose
Treatment options for CSF leaks depend on the cause and location of the leak. In general, conservative treatments are usually applied first for CSF leaks through the nose and ears.
3.1. Conservative treatment Bed rest (several days to 2 weeks) Drink plenty of fluids (2 to 3 liters) Intravenous fluids Avoid coughing, sneezing, blowing your nose, lifting heavy objects, and taking stool softeners to avoid straining during bowel movements. Avoid using straws Avoid bending, lifting, stretching and twisting Keep your back straight during all movements (bends at the knees and hips) 3.2. Surgical Treatments If conservative treatments are not successful in stopping CSF leakage, more invasive procedures are used.
Surgical repair of cerebrospinal fluid leak depends on the size and location of the leak. A CSF leak through the nose can usually be done with endoscopic rhinoplasty and patching the fistula. Patch the fistula using synthetic grafts, body tissues such as fat, muscle, and mucosa, or adhesives.
In summary, CSF leakage through the nasal passage creates communication between the CSF compartment and the nasal cavity. This is a favorable condition for bacteria to enter, causing infections such as rhinitis, meningitis, even with a high risk of death. Headache, clear nasal discharge, and recurrent meningitis are the most common symptoms of a nasal CSF leak. Treatment consists of conservative treatment and endoscopic transnasal surgery to patch the fistula.
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Reference source: my.clevelandclinic.org
