CSF rhinorrhea “immediate” management is
Correct Answer: Wait & watch for 7 days + antibiotics
Description: CSF rhinorrhea may be classified as: Traumatic (>90%) - Approximately 80% of all traumatic leaks occur in the setting of accidental trauma, and the remaining traumatic leaks occur after neurosurgical and rhinological procedures Nontraumatic (Nontraumatic etiologies include neoplasms and hydrocephalus High pressure flow- intracranial tumours & hydrocephalous Low pressure flow- congenital defects Most common site for leak is through cribform plate and ethmoidal air sinuses. Less common sites are through frontal and sphenoidal sinuses. Rarely, the leak can originate in the middle or posterior cranial fossa and can reach the nasal cavity by way of the middle ear and eustachian tube Diagnosis: Basic clinical tests - Rhinoscopy-visualisation of CSF leakage from paranasal sinuses - Tissue test-unlike nasal mucous ,CSFdoes not cause a tissue to stiffen - Filter paper test-sample of nasal discharge on a filter paper exhibits a light CSF border and a dark central area of blood 'double ring sign' or ' halo sign' (in cases of traumatic CSF leak where blood and CSF are mixed.) - Queckenstedt test-compression of jugular veins leads to increased CSF leakage d/t increase in 1CP Biochemical tests: - Concentrations of glucose & protein are higher in CSF than in nasal discharge. - 12-transferrin is the preferred biochemical marker of CSF. It helps in distinguishing CSF from other nasal secretions. - Beta-trace protein (11TP) is another chemical marker that could be used for the detection of CSF CSF tracers: Intrathecal fluorescein dye administration, radionuclide cisternography, CTcisternography Radiological studies: High-resolution CT provides detailed information about the bony skull base anatomy, and MR1 assesses soft tissues , including unrecognized tumors and coincidental meningoencephaloceles Treatment: Traumatic rhinorrhea often stops spontaneously Conservative treatment consists of 1-2 weeks trial of? - Strict bed rest - Head elevation - Stool softeners - Advising patient to avoid coughing, sneezing, nose blowing, and straining - Prophylactic antibiotics - Subarachnoid drainage through a lumbar catheter Surgical repair is generally advocated in patients with large fistulas especially in the presence of pneurnocephalous.
Category:
ENT
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