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Dr. Andrew Rynne

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Have running nose and found reduction in cerebrospinal fluid. What could it be?

Answered by
Dr. Prahlad Duggal

ENT Specialist

Practicing since :1998

Answered : 784 Questions

Posted on Fri, 29 Nov 2013 in Ear, Nose and Throat Problems
Question: hi, my sister has running nose,though initially we thought its allergic common cold it did not stop even after 20 days. its watery liquid which leaks once a while with few contiguous flow of droplets. i later found about CSF decease with similar symptoms. we had a test done and found glucose in those droplets. what are the best ways to cure this? and can we treat this without surgery? Are there any stages of this? and why did it happen to my sister ? the reasons why this happens?
Answered by Dr. Prahlad Duggal 3 hours later
Brief Answer: Beta2 transferrin test, diamox tablet Detailed Answer: Hi, You are suspecting a CSF leak from brain into the nose. Glucose estimation in the nasal secretions is an indicator used for diagnosis but not a recommended one diagnosis as there can be various causes for this glucose test positive other than CSF. Usually CSF leak is unilateral but can be bilateral. The single best test for confirmation of CSF in sinonasal fluids is Beta 2 transferrin estimation. Other tests which are needed are CT cisternography and endoscopic examination. There are no stages described for this condition. Among the causes most common is trauma, whether RSA or iatrogenic. It can also start spontaneously with no know cause. Some tumours or condition which can raise pressure of CSF can also lead to this. Medical treatment is- Strict bed rest, cough suppressants, stool softeners, Diamox tablets (Consult an ENT/neuro for prescription). Surgical treatment is used only when medical measures fail to stop it. Surgical treatment is localizing the site of leak, and plugging it with fat, fibrin glue, fascia XXXXXXX and cartilage for bony defect repair. The use of prophylactic antibiotics is not recommended in this condition. Take care
Above answer was peer-reviewed by : Dr. Vaishalee Punj
Follow up: Dr. Prahlad Duggal 2 days later
hi doctor a MRI scan was conducted of brain in CSF area but nothing was found.can this be any sinus related problem. the fluid has reduced by about 50% as she is having tablet zocef 250 mg.we have shown to a neurologist but the leak or reason is not yet understood.
Answered by Dr. Prahlad Duggal 8 hours later
Brief Answer: Can be a possibility Detailed Answer: Hi, Simple MRI brain is not the investigation of choice and cisternography is the investigation which helps in localizing the site of leak and even that is not always helpful in finding leak site. Various other modalities like putting fluorescein dye in the csf space and localizing the leak in nose using blue light with endoscopes is also used. Sinus related problems can also produce rhinorrhea but your CT PNS should also show some finding in PNS. Many a times the leak is not localized and with conservative measures like rest and spontaneously also it stops. So, discus with your ENT or neurosurgeon about the possibilities and things should be fine. Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj

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