Related Subjects:
|Lumbar Puncture
|CSF Interpretation
|CSF Rhinorrhoea
🧪 CSF Rhinorrhoea Testing: Used to confirm if nasal or oral fluid after trauma or surgery is cerebrospinal fluid (CSF). The presence of β-2 transferrin (tau protein) is diagnostic, as this protein is unique to CSF. Early identification is vital to prevent meningitis and guide neurosurgical management.
ℹ️ About
- 🕒 Turnaround time for lab testing may be several weeks – clinical suspicion remains key.
- 👃 Helps confirm suspected CSF leak in patients with clear nasal/oral discharge after trauma or surgery.
🧬 Aetiology
- 🤕 Trauma: Skull base fracture (cribriform plate, temporal bone).
- 🔪 Surgical: Post-neurosurgery or ENT procedures (e.g. pituitary surgery).
- 🧫 Pathological: Tumours, congenital skull base defects, infiltrative lesions.
🩺 Clinical Features
- 💧 Persistent clear watery discharge (often unilateral, worse on leaning forward – “reservoir sign”).
- 🩸 Salty taste or clear fluid in throat.
- 🧠 History of trauma, neurosurgery, or sinus disease.
- 🔁 Recurrent meningitis may suggest chronic leak.
🔎 Investigations
- 🧾 Bloods: FBC, U&E, CRP, LFT.
- 🧪 CSF-specific Protein: β-2 transferrin (tau protein) – highly specific for CSF.
- 🖼️ Imaging: CT/MRI head ± CT cisternography to localise defect.
Pathology Considerations
- 💀 Exclude skull base fracture.
- 🦠 Rule out erosive/infiltrative tumours.
💊 Management
- 🛌 Conservative: Bed rest, head elevation, avoid straining/nose blowing – small leaks may self-resolve.
- 💊 Medical: Antibiotics use debated; consider if recurrent meningitis.
- 🔧 Surgical: Endoscopic skull base repair if persistent/recurrent leak.
- 🎯 Treat underlying cause: Repair fracture, excise tumour, manage raised ICP.
References
