title: More than just a 'runny nose': a rare diagnosis of spontaneous CSF rhinorrhoea for a common symptom.
abstract: Primary spontaneous cerebral spinal fluid (CSF) rhinorrhoea is a rare disease associated with female gender, obesity and empty sella syndrome. The authors describe the case of a 59-year-old woman who presented to her primary care physician with a 2-week history of drainage of a clear fluid from her right nostril that was initially treated as allergic rhinitis. A non-contrast CT scan revealed mucosal thickening in the right sphenoid sinus and a possible defect in the adjacent skull base. The patient initially declined a CT cisternogram, which provides greater sensitivity in assessing for a CSF leak. Nasal secretions tested positive for β-2-transferrin, which is highly sensitive and specific for CSF. After conservative interventions failed, a pedicled septal mucoperichondrial flap was used to patch the skeletal defect. At her 5-month follow-up, the patient remains asymptomatic.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Aaron Elias
authors.initials: AE
authors.lastname: Berhanu
authors.affiliation: Brigham and Women's Hospital, Chestnut Hill, Massachusetts, USA.
authors.forename: Natalie P
authors.initials: NP
authors.lastname: Pauli
mesh_terms: D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D065631:Rhinitis, Allergic / Q000175:diagnosis; D014057:Tomography, X-Ray Computed