Leakage of CSF into the nose is called CSF rhinorrhea. It may be clear fluid or mixed with blood as in acute head injuries. TRAUMA. Most of the cases follow trauma.it can be accidental or surgical. Inflammation, mucoceles of sinuses, sinunasal polyposis, fungal infection of sinuses & osteomyelitis, can all erode the bone and dura. Neoplasms, idiopathic- where cause is unknown and patient has spontaneous leak. SITE OF Leakage- CSF from anterior cranial fossa reaches the nose (1) cribriform plate, (2) roof of ethmoid air cells or (3) frontal sinus. CSF from middle cranial fossa follows injuries to sphenoid sinus, cribriform plate. In fracture of temporal bone, CSF reaches the middle ear and then escapes through the Eustachian tube into the nose (CSF OTORHINORRHOEA) DIAGNOSIS- there is history of clear watery discharge from the nose on bending the head or straining. CSF rhinorrhea should be differentiated from nasal discharge as the former is sudden, gushes in drops when bending and cannot be sniffed back. CSF rhinorrhea after head trauma is mixed with blood and shows "target sign" when collected on filter paper.it shows central red spot and peripheral lighter halo sign. LAB TEST = BETA-2 transferrin is seen in CSF and not in the nasal discharge. its presence is a specific and sensitive test.
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