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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Can The Medicine, Diamox, Cure Intermittent CSF Rhinorrhea Or Is Surgery Required?

Last year my mother had issue of csf rhinorrhea. So ENT doctor suggested for endoscopic surgery after which everything was fine for 6 months. After 6 months she had intermittent complain of CSF coming via nose. We checked with ENT team but as per there endoscopic report they didn t find any open hole. Last week she had problem of high fever and was unconscious. Later she was diagnose with meningitis which was cured after week of vaccination. Further doctor suggested for MRI scan (there was leak) in which we can see open hole. After which we consulted neuro surgeon they confirmed hole is still there and we need to open brain to fix it. So looking this to be big and complex surgery I consulted ENT team and they again did endoscopic (as I mentioned this CSF leak is intermittent, so during endoscopic check up there was no leak) and mentioned there is no leak. As per them this intermittent leak can be due to high CSF pressure and suggested for diamox 500 mg. So just wanted to check: 1) only having diamox can this heal. 2) is this possible that due to CSF pressure she is seeing intermittent leak. 3) should we go for suggestion provided by neuro team. Thanks.
Tue, 27 Sep 2016
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Neurologist, Surgical 's  Response
Hi,I have read your case details .

Before giving my opinion, I would like to know that Ct cisternogram has been done or not .

If it is not done I would advise you to do it.

I. tab diamox can reduce csf rhinorrhea but can not heal it.

2.No, she is having csf rhinorrhea due do bony defect at he base of skull not due to csf pressure.

3.You should go with advise of neurosurgeon .

Plan should be ACF repair to stop it as she is having recurrent rhinorrhea after failed endoscopic repair. Thanks


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Can The Medicine, Diamox, Cure Intermittent CSF Rhinorrhea Or Is Surgery Required?

Hi,I have read your case details . Before giving my opinion, I would like to know that Ct cisternogram has been done or not . If it is not done I would advise you to do it. I. tab diamox can reduce csf rhinorrhea but can not heal it. 2.No, she is having csf rhinorrhea due do bony defect at he base of skull not due to csf pressure. 3.You should go with advise of neurosurgeon . Plan should be ACF repair to stop it as she is having recurrent rhinorrhea after failed endoscopic repair. Thanks