Trauma is the most common cause of CSF rhinorrhea. Causes of CSF rhinorrhea: Trauma (accidental or surgical) Inflammations Neoplasms Congenital lesions Idiopathic - CSF can escape from following routes: Middle/posterior fossa mastoid cavity, sphenoid sinus Anterior cranial fossa : Frontal, Ethmoid Sphenoid sinus Cribriform plate From middle ear eustachian tube Difference between CSF And Nasal Secretions CSF Nasal secretions History Trauma, Tumour Sneezing, stuffiness, Itching Character Thin, Watery and Clear Mucous/ Mucopurulent Aggravation Coughing, Straining, Sneezing, Bending forwards Allergy, Infection, crying Sniff Test Negative Positive Handkerchief Test Negative (Does not stiffen the Handkerchief) Positive Sugar Test *> 30mg/dl < 10 mg/dl B2Transferrin Present Absent CSF rhinorrhea can be managed by Conservative approach Bed rest Elevating head of bed Stool softeners Avoidance of sneezing/straining activities Surgical repair: In persistent cases surgical repair is performed by Neurosurgical intracranial approach Endoscopic repair Extradural approach