Related Subjects:
|Lumbar Puncture
|CSF Interpretation
|CSF Rhinorrhoea
๐งช CSF Rhinorrhoea Testing: Used to confirm if nasal or oral fluid after trauma or surgery is cerebrospinal fluid (CSF). The presence of ฮฒ-2 transferrin (tau protein) is diagnostic, as this protein is unique to CSF. Early identification is vital to prevent meningitis and guide neurosurgical management.
โน๏ธ About
- ๐ Turnaround time for lab testing may be several weeks โ clinical suspicion remains key.
- ๐ Helps confirm suspected CSF leak in patients with clear nasal/oral discharge after trauma or surgery.
๐งฌ Aetiology
- ๐ค Trauma: Skull base fracture (cribriform plate, temporal bone).
- ๐ช Surgical: Post-neurosurgery or ENT procedures (e.g. pituitary surgery).
- ๐งซ Pathological: Tumours, congenital skull base defects, infiltrative lesions.
๐ฉบ Clinical Features
- ๐ง Persistent clear watery discharge (often unilateral, worse on leaning forward โ โreservoir signโ).
- ๐ฉธ Salty taste or clear fluid in throat.
- ๐ง History of trauma, neurosurgery, or sinus disease.
- ๐ Recurrent meningitis may suggest chronic leak.
๐ Investigations
- ๐งพ Bloods: FBC, U&E, CRP, LFT.
- ๐งช CSF-specific Protein: ฮฒ-2 transferrin (tau protein) โ highly specific for CSF.
- ๐ผ๏ธ Imaging: CT/MRI head ยฑ CT cisternography to localise defect.
Pathology Considerations
- ๐ Exclude skull base fracture.
- ๐ฆ Rule out erosive/infiltrative tumours.
๐ Management
- ๐ Conservative: Bed rest, head elevation, avoid straining/nose blowing โ small leaks may self-resolve.
- ๐ Medical: Antibiotics use debated; consider if recurrent meningitis.
- ๐ง Surgical: Endoscopic skull base repair if persistent/recurrent leak.
- ๐ฏ Treat underlying cause: Repair fracture, excise tumour, manage raised ICP.
References
