After Xiao Zhao fell down the stairs a few years ago, his left nostril has been “running clear snot” for many years, and when he looked at the community clinic, he first thought he had a cold, and then considered whether he had “allergic rhinitis”. He took medicine and nose spray, but the “runny nose” has not been solved at all, and has been intermittent, erratic, and seemingly absent. One day a few years ago, Xiao Zhao suddenly began to severe headache, nausea, jet vomiting, high fever, soon also appeared coma phenomenon, family members quickly sent Xiao Zhao to the hospital rescue. He was diagnosed with “acute meningitis”, and after full treatment, he was saved and returned home safely, but what he didn’t expect was that since then, “acute meningitis” has followed Zhao like a lingering ghost, every few months. The first time I saw him, I had to go through the above process: “headache, nausea, jet vomiting, high fever, hospitalization, treatment, discharge”, and after he recovered from the meningitis three months ago, an attentive neurologist noticed that Xiao Zhao had been “running clear” and reminded him that it was best to The company’s main business is to provide a wide range of products and services. The otolaryngologist told Zhao that he had cerebrospinal fluid rhinorrhea, which means that what comes out of his nose is not snot but cerebrospinal fluid, and that he needed to be hospitalized for further examination and treatment. Cerebrospinal fluid rhinorrhea is the flow of intracranial cerebrospinal fluid out of the nose, and the risk of this disease is very high, which may cause recurrent intracranial bacterial infections and may otherwise be life-threatening. Cerebrospinal fluid nasal leakage is the flow of cerebrospinal fluid through the skull base (anterior, middle or posterior fossa of the skull) or other parts of the skull where bone defects or ruptures occur, through the nasal cavity, and eventually out of the body. Common causes include congenital or traumatic injuries that result in bone defects or ruptures at the skull base or other parts of the skull. Xiao Zhao had a nasal leak of cerebrospinal fluid due to trauma. There is a layer of water on the surface of the brain and spinal cord, medically called cerebrospinal fluid, which is stored in an airtight spinal capsule cavity, from head to tail, up and down, maintaining a certain tension, like a cushion to cushion and nourish our central nervous system, but whether congenital or acquired, over time, the cerebrospinal capsule inevitably breaks, resulting in cerebrospinal fluid leakage, and cerebrospinal fluid leakage is like a festering hole under a thousand-mile long dike, threatening our The cerebrospinal fluid leak is like a festering hole under a thousand-mile dike, threatening our health. The top of our nose, which is part of the skull base, is also a relatively weak area and is a good site for cerebrospinal fluid leakage. Due to the complexity of the clinical manifestations and imaging features, and the lack of awareness among physicians, the diagnosis may be delayed for months, years or even decades. 1. What are the symptoms of cerebrospinal fluid nasal leakage? The main manifestation is clear water dripping from the nose. Patients generally have an intermittent or continuous flow of clear, watery fluid from the nose. Most are unilateral. It increases when the head is lowered, lying down, turning over, constipation and bending over. This is mainly because the above actions increase the pressure inside the skull, resulting in increased leakage of cerebrospinal fluid. In clinical practice, doctors often ask patients to lower their heads and exert force, or compress their jugular veins to observe whether the flow of clear nasal fluid increases to initially infer the possibility of cerebrospinal fluid nasal leakage. For patients with traumatic cerebrospinal fluid nasal leakage like Xiao Zhao, there may be a simultaneous flow of bloody fluid from the nostrils with a red center and clear periphery, or colorless fluid from the nostrils that is not crusty after drying. Most of them appear immediately after the injury, and late onset may appear after several days, weeks or even years. 2.What are the common causes of cerebrospinal fluid rhinorrhea? The causes of cerebrospinal fluid nasal leakage can be divided into traumatic and non-traumatic, of which traumatic can be divided into traumatic and medical; non-traumatic can be divided into spontaneous, neoplastic and congenital. (1) Most of them are caused by trauma, surgery or even some firing treatments that damage the skull base, resulting in a weak area where the intracranial blood vessels pulsate and transmit the pressure of cerebrospinal fluid, which, with the accumulation of time, causes a perforation of the dura mater at the base of the skull that has already been destroyed and causes an intracranial communication with the nasal cavity. This results in cerebrospinal fluid leakage (cerebrospinal fluid nasal leak), intracranial infection (bacteria in the nose entering the skull), or pneumocranial (air entering the skull). (2) There are also spontaneous cerebrospinal fluid nasal leaks, which tend to occur in women, those with chronic illnesses such as hypertension, or those who have had huge setbacks in their lives. These may be the triggers of spontaneous cerebrospinal fluid rhinorrhea. 3.How to diagnose cerebrospinal fluid rhinorrhea? The diagnosis of cerebrospinal fluid nasal leakage mainly relies on symptoms, signs and auxiliary examinations. Symptoms: Continuous or intermittent flow of clear fluid from one or both nostrils, aggravated by tilting to one side, lowering the head or compressing the jugular vein. It also presents only with recurrent intracranial bacterial infections, and nasal leakage is not obvious. The onset of rhinorrhea is usually after cranial trauma or surgery, while a few patients have only a history of minor cranial trauma or after sneezing. The key points of diagnosis include: (1) Qualitative diagnosis, i.e., is this a cerebrospinal fluid rhinorrhea? It is usually determined by the physician based on past history, such as history of cranial trauma, history of running nose, history of intracranial infection, and high-resolution CT or MRI of the skull base of the sinuses. And the clear water left in the nose for routine and biochemical determination of cerebrospinal fluid has significant guiding significance. (2) Localization diagnosis: It mainly relies on high-resolution CT or MRI of the skull base of the sinuses for judgment. Some leaks, with typical features, can be determined by the doctor at that time. However, some leaks are abnormally narrow and concealed, which is difficult to determine on the image. In this case, a careful nasal endoscopy is needed again. 4.How is cerebrospinal fluid nasal leak treated? For cerebrospinal fluid nasal leakage, surgery is definitely not required as soon as it is detected, in fact, a large proportion of patients can be cured by conservative treatment. In general, patients with cerebrospinal fluid nasal leakage should be treated conservatively first, especially for traumatic cerebrospinal fluid nasal leakage. The course of treatment can depend on the condition and is usually about 2 to 4 weeks, during which time it should be closely observed. The main measures of conservative treatment are: (1) bed rest; (2) keep the nasal cavity clean; (3) prevent the increase of intracranial pressure; (4) prevent infection. The difficulty in surgery is to determine the location of the leak, carefully search for the source of cerebrospinal fluid nasal leak with the help of nasal endoscopy, then remove the granulation tissue and necrotic tissue around the leak, fully flush the area, use repair materials, fully cover the leak and compress it. An endoscopic, minimally invasive approach to repair is used while avoiding craniotomy. The overall success rate is higher than 90%.