CSF leak

Background: CSF leak usually presents with unilateral clear rhinorrhoea made worse by straining. There may be no other nasal symptoms. CSF leak most commonly occurs following trauma but can occur spontaneously. If spontaneous, it is often associated with obesity or benign intracranial hypertension. Left untreated, CSF leak is thought to increase the risk of meningitis.

How to manage:

Complete full neurological exam

Some cases may improve with weight loss and avoiding straining (e.g. stool softeners if constipated)

Give the patient a universal container and advise the patient to try and collect a sample of the fluid by dripping it into the container. Only a small volume needs to be collected for testing.

Most cases will resolve spontaneously

Referral guidance:

If altered neurology, send to nearest emergency department

Refer any patient with suspected CSF leak to ENT on an urgent basis and advise them to try to collect a sample prior to their appointment so that this can be sent for testing to confirm whether it is CSF or not. Imaging may also be required.