Some individuals may develop acute meningitis secondary to skull defect between the anterior cranial fossa and the nasal cavity. The presence of CSF rhinorrhea in the previous days is the clue for the diagnosis. This symptom orient to order specific neuroimagen tests, as the high-resolution computed tomography scan (HRCT), with the aim to locate the skull defect. Routine biochemical tests are performed to establish the differential diagnosis between CSF and nasal discharge. Glucose is higher in CSF and proteins are higher in mucus. The presence of Beta 2-transferrin also is orientative of CSF. The ethiological microorganisms are those common of superior respiratory tract, which may be treated with conventional antibiotics schemes. If the CSF leak doesn't close spontaneuosly in 7-10 days, it’s necessary a neurosurgical/ENT consult to repair the skull defect for avoiding a recurrence.
Gretchen et al propose a practical algortihm to approach these situations:
Sources and images:
- Shelesko EV, Kravchuk AD, Kapitanov DN, Chernikova NA, Zinkevich DN. Sovremennyĭ podkhod k diagnostike nazal'noĭ likvorei [A modern approach to the diagnosis of nasal liquorrhea]. Zh Vopr Neirokhir Im N N Burdenko. 2018;82(3):103-111. Russian. doi: 10.17116/neiro2018823103. PMID: 29927432.
- Gretchen MO, Jeremiah A, Schlosser RJ, Harvey RJ, Orlandi RR. Diagnosis of cerebrospinal fluid rhinorrhea: an evidence-based review with recommendations. International Forum of Allergy & Rhinology. 2016;6:1.
- https://pgblazer.com/cerebrospinal-fluid-csf-vs-nasal-discharge-differences/
