CSF rhinorrhea: a rare manifestation of benign intracranial hypertension

Background: The development of a cerebrospinal fluid (CSF) leak is, in the majority of cases, a manifestation of head trauma. Patients manifesting spontaneous CSF rhinorrhea most often are found to have some congenital anomaly, such as focal atrophy of the cribriform plate or sella turcica. Spontaneous CSF rhinorrhea has been described as a symptom of idiopathic intracranial hypertension in a few cases in the literature.

Objective: To describe the case of a patient with CFS leaking, which was etiologically associated with idiopathic intracranial hypertension.

Methods: Case report.

Results: A 44-year-old-woman developed nasal dripping of clear fluid which was particularly intense in the morning. The fluid contained 82 mg/dl glucose, while immunofixation electrophoresis for -2 transferin was positive. The patient had a known history of idiopathic intracranial hypertension, which was relatively resistant to treatment with Acetazolamide and repeated lumbar punctures. The patient reported no previous head trauma. She underwent computerized tomography (CT) cisternography, which revealed presence of the contrast agent in the anterior ethmoid cellulae, suggesting leaking through the adjacent part of the cribriform plate. A ventriculoperitoneal shunt was placed, in order to control the underlying high intracranial pressure and since then the rhinorrhea has stopped.

Conclusions: Idiopathic intracranial hypertension is thought to be a cause of the so-called high-pressure leaks. In this paper we briefly the discuss pathogenic relationship between these disorders, the diagnostic evaluation and the surgical procedures of non-traumatic leaks.

Key words: CSF rhinorrhea, idiopathic intracranial hypertension.