Spontaneous CSF Rhinorrhea and IIH

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can someone please direct me to articles in relation to Spontaneous CSF rhinorrhea and people with IIH. one of my regulars is an IIH patient and she's been complaining of a 'runny nose' so i gave her a yellow top to catch some so i could test it. i can't seem to find what i'm looking for which is just some information and details on what i should be looking for ...i've never heard of this until now

Originally Posted by BushDoc20

can someone please direct me to articles in relation to Spontaneous CSF rhinorrhea and people with IIH. one of my regulars is an IIH patient and she's been complaining of a 'runny nose' so i gave her a yellow top to catch some so i could test it. i can't seem to find what i'm looking for which is just some information and details on what i should be looking for ...i've never heard of this until now

This is a tough one. I actually hadn't ever heard of this before.

Here is an article mentioning CSF leak and IIH:

http://www.ncbi.nlm.nih.gov/pubmed/21476806

And another on spontaneous CSF leaks (also being linked to IIH):

http://www.ncbi.nlm.nih.gov/pubmed/21819875

And:

http://www.ncbi.nlm.nih.gov/pubmed/17606039

Here is an interesting article about CSF rhinorrhea in a patient with pseudotumor cerebri and a venous sinus obstruction:

http://www.ncbi.nlm.nih.gov/pubmed/12779209

There were other, exotic causes as well such as fistulae and meningocoeles. All of these articles were on PubMed. I just typed in "CSF rhinorrhea idiopathic intracranial hypertension" and was off to the races.

Good luck with your case. If the fluid is indeed CSF, then the patient bought herself a referral to a neurosurgeon or otolaryngologist and detailed imaging of her brain/skull.

I had one case s/p transphenoidal hypophysectomy :-) . One year after that is :-)

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If you are asking "How do I test for a CSF leak?", then people generally run a radioisotope tracer test. Basically a radioisotope is injected into the CSF via a lumbar puncture, then the nose and ears are plugged to capture any fluid. They undergo a SPECT scan about a day later. The nose and ear plugs are then tested for the radioisotope.

CSF is not specific enough in its composition to easily distinguish it from other sources of fluid when captured from a running nose without a radioisotope. Note that the radioisotope testing does not always identify small leaks. You can read about this study by searching for "csf cisternography".

These can be very difficult cases. Practically speaking cisternography can be helpful if positive. If the diagnosis is IIH, then hospitalized bedrest (that's the only bedrest) and caffeine can be therapeutic and diagnostic. Because the nasal symptoms could be a red herring I rec: image the spine with MRI.

How about the old fashioned tests first? Have your friend let some of the fluid from her nose accumulate on a tissue, snot turns stiff, CSF stays soft. There's also a nasal mucin precipitation test -> Drop a bit of the fluid in a bottle of vodka, snot won't dissolve but CSF will.

High resolution facial ct with looking at ethmoid and sphenoid sinuses along with cisternography will help, usually history helps, that csf leak can be positional too.

It should be fixed soon, because of the risk of basilar meningitis with unusual bugs and high risk of morbidity and mortality.