Cerebrospinal fluid rhinorrhea

Introduction Cerebrospinal fluid rhinorrhea (CFR) is a cerebrospinal fluid (CSF) that flows out through the skull base (pre-cranial, middle or posterior fossa) or other parts of the bone defect and rupture, passes through the nasal cavity, and eventually flows out of the body. Mainly manifested as nasal intermittent or continuous flow of clear, watery liquid, early mixed with blood, the liquid can be light red. More common on one side. In the case of a low-head force, compression of the jugular vein, etc., there is a tendency to increase the flow rate, suggesting that the cerebrospinal fluid rhinorrhea may be. Traumatic cerebrospinal fluid rhinorrhea can also have bloody fluid flowing out of the nostrils at the same time. The center of the trace is red and the periphery is clear, or the colorless liquid flowing out of the nostrils does not appear sick after drying. The cerebrospinal fluid rhinorrhea should be thought of. It occurs more often after injury, and late-onset can occur in days, weeks, or even years.

Cause

Classification by cause

Generally, it can be divided into two types according to the cause of traumatic and non-traumatic CSF rhinorrhea. The former is divided into traumatic and iatrogenic, the latter is divided into congenital, spontaneous (also known as primary cerebrospinal fluid rhinorrhea, also known as idiopathic) and CSF leakage caused by tumor or suppurative inflammation.

an examination

Related inspection

ECT examination of nasal endoscopy, nasal radiography, intraspinal injection of markers

Nasal endoscopy

Can be used routinely, positioning leaks accurately. When the cerebrospinal fluid continues to flow out, the endoscope may directly find the part of the cerebrospinal fluid rhinorrhea. When the cerebrospinal fluid leaks less or intermittently flows out, intrathecal fluorescein may be used together to find the leak. During the examination, the intracranial pressure of the bilateral internal jugular vein was increased, which was beneficial to the observation of the leak.

Glucose oxidase assay

This technique is a traditional diagnostic method. Because tears and nasal mucus are sugary, the sugar is not reliable and can be quantitatively tested. The concentration of glucose in the nasal leakage is measured and compared with the concentration of glucose in the serum. If the ratio is 0.50 to 0.67, the leakage is likely to be cerebrospinal fluid under other factors that may cause changes in the concentration of glucose in the cerebrospinal fluid and serum. If the glucose concentration in the leakage liquid is greater than 1.7mmol, the diagnosis can be confirmed.

-2-2 transferrin assay

This technique is very effective in the diagnosis of cerebrospinal fluid rhinorrhea. Since -2 transferrin is only present in the cerebrospinal fluid and the inner ear lymph, it is not detectable in the blood, nasal and external auditory canal secretions. 0.2 mL of the specimen was taken and detected by immunofixation electrophoresis, and its sensitivity and specificity were high.

--2 tracer protein detection

In recent years, it has been found that the -2 tracer protein is only present in the cerebrospinal fluid and the outer ear lymph, and its sensitivity and specificity are higher.

CT and CT cerebral angiography

High-resolution CT, the layer thickness can be as thin as 1 mm, and the detection rate of small lesions is significantly improved. Three-dimensional CT imaging technology to reconstruct the skull base, more intuitive display of fractures, to identify the leak site. CT cerebral cisography has a high specificity and can directly display the shape, size, location and number of leaks in cerebrospinal fluid rhinorrhea. However, it is not possible to fully understand the leak condition, and the bone structure is unclear. Combined with CT, it is more perfect.

Intrathecal and local fluorescein method

Intrathecal injection of fluorescein combined with endoscopy is a common method for intraoperative cerebrospinal fluid leakage, which is helpful for the diagnosis of cases with less leakage or intermittent cerebrospinal fluid rhinorrhea. The intraoperative visual field exposure is larger and the diagnosis is accurate, but the exposure to the skull base defect is small, and the precise positioning of the leak is limited. Local intranasal fluorescein method can be used for preoperative diagnosis, intraoperative localization and postoperative recurrence. It is non-invasive, simple and safe, and has high sensitivity.

MRI and MRI water imaging

The most easily leaking position of the cerebrospinal fluid, that is, the prone position, the T1-weighted T2-weighted image of the axial, sagittal or coronal position and the fast spin echo T2 weighted image of fat suppression can be used to determine the cause and leakage. Part. MRI water imaging technology, which is widely used, locates leaks accurately.

Differential diagnosis

Allergic rhinitis

Symptoms of watery sputum may appear in the onset of allergic rhinitis and should be differentiated from this disease. However, allergic rhinitis is accompanied by continuous sneezing, nasal itching, nasal congestion, and has a clear allergen. Biochemical examination of secretions can be identified.

Submucosal cyst of the sinus

Submucosal cysts of the sinus are most common in the maxillary sinus. When the cyst is ruptured, yellow liquid can flow out. One side should be identified. Feasible imaging and biochemical tests.

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