title: Cerebrospinal fluid leakage--reliable diagnostic methods.
abstract: Prompt diagnosis and early treatment of cerebrospinal fluid (CSF) leakage minimizes the risk of severe complications. In patients presenting with clear fluid nasal discharge it is important to identify the nature of the rhinorrhea. The CSF leakage may occur as post-traumatic, iatrogenic, spontaneous or idiopathic rhinorrhea. The differential diagnosis of CSF rhinorrhea often presents a challenging problem. The confirmation of CSF rhinorrhea and localization of the leakage may be diagnosed by CT, MRI cisternography and MRI cisternography in combination with single photon emission tomography or radioisotopic imaging. Although these methods allow estimation of the CSF leakage with high accuracy, they are expensive and invasive procedures. Therefore, biochemical methods are still used in the differentiation. Although the most common diagnostic method for screening CSF leakage is glucose oxidase, its diagnostic sensitivity and specificity is generally unsatisfactory. False negative results may occur with bacterial contamination and false positive results are common in diabetic patients. Glucose detection is not recommended as a confirmatory test. As such, other biomarkers of the CSF leakage, such as beta-2-transferrin (beta-2 trf) and beta-trace protein (betaTP) are necessary to identify and confirm of this condition.
authors.affiliation: Department of Clinical Laboratory Diagnostics, Medical University, Białystok, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Mantur
authors.forename: Marta
authors.initials: M
authors.lastname: Łukaszewicz-Zając
authors.forename: Barbara
authors.initials: B
authors.lastname: Mroczko
authors.forename: Alina
authors.initials: A
authors.lastname: Kułakowska
authors.forename: Oliver
authors.initials: O
authors.lastname: Ganslandt
authors.forename: Halina
authors.initials: H
authors.lastname: Kemona
authors.forename: Maciej
authors.initials: M
authors.lastname: Szmitkowski
authors.forename: Wiesław
authors.initials: W
authors.lastname: Drozdowski
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Zimmermann
authors.forename: Johannes
authors.initials: J
authors.lastname: Kornhuber
authors.forename: Piotr
authors.initials: P
authors.lastname: Lewczuk
mesh_terms: D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis* / Q000201:enzymology / Q000378:metabolism; D019793:Fluorescein / Q000008:administration & dosage; D005949:Glucose Oxidase / Q000378:metabolism; D006801:Humans; D019746:Intramolecular Oxidoreductases / Q000032:analysis; D054834:Lipocalins / Q000032:analysis; D059906:Neuroimaging; D014168:Transferrin / Q000032:analysis
chemical_list: D054834:Lipocalins; D014168:Transferrin; D005949:Glucose Oxidase; D019746:Intramolecular Oxidoreductases; C022466:prostaglandin R2 D-isomerase; D019793:Fluorescein