Rhinorrhoea feigning cerebrospinal fluid leak: nine illustrative cases.
Before contemplating surgery for cerebrospinal fluid (CSF) rhinorrhoea it is vital that the correct diagnosis is established. This can be done using immunofixation of beta-2-transferrin, that is nearly always positive in cases of CSF rhinorrhoea. Fluorescein lumbar puncture is useful in establishing the exact site of a leak and also in confirming the absence of a leak where the clinical suspicion is high but the beta-2-transferrin is negative. High resolution computed tomography (CT) scanning is a useful radiological investigation for identifying a bony defect. We present nine patients who presented with clear rhinorrhoea that was clinically highly suggestive of a CSF leak. Three of these patients had undergone previous craniotomies for presumed CSF rhinorrhoea. The diagnosis of CSF rhinorrhoea was excluded in all patients using beta-2-transferrin with or without fluorescein lumbar puncture. The authors believe that measurement of beta-2-transferrin should be mandatory before surgery for CSF rhinorrhoea.
Bateman
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N
Department of ENT Surgery, Royal Hallamshire Hospital, Sheffield, UK.
Jones
N S
NS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009668:Nose Diseases / Q000175:diagnosis*; D012220:Rhinitis / Q000175:diagnosis; D013129:Spinal Puncture / Q000379:methods; D014057:Tomography, X-Ray Computed; D014168:Transferrin / Q000134:cerebrospinal fluid*
D014168:Transferrin