EpistemisRhinoliquorrhea
Specialty: Otolaryngology.
Why it occurs
- Fracture of the cribriform plate of the ethmoid after blunt facial trauma or head trauma
- Erosion of the skull base due to spontaneous fistula associated with chronic idiopathic intracranial hypertension
- Iatrogenic complication of endoscopic sinonasal surgery or resection of skull base tumors
- Chronic osteomyelitis of the bones of the skull with fistula of the underlying dura mater
Initial workup
Analysis of the nasal discharge to quantify beta-2 transferrin, high-resolution CT of the paranasal sinuses with millimetric slices, and MR cisternography with high spatial resolution T2 sequences to visualize the dural defect and the meningeal protrusion.
red flags
Constant unilateral dripping of clear liquid like water when lowering the head (tilt sign or "reservoir sign"), intense headache that improves when lying down and worsens standing up (orthostatic headache), neck stiffness with fever, mental confusion, pronounced photophobia or explosive nausea.
Standard management
- Pneumococcal conjugate and polysaccharide vaccination preventively in the event of persistent fistula
- Systemic antibiotic prophylaxis not routinely recommended due to the risk of selecting resistant strains, except if surgical intervention is decided or there are signs of suspected meningitis — cefotaxime 2 g every 6 hours intravenously
- Avoid nasal washing with a pressure syringe and sneezing with your mouth open.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 4
- Treatment options
- 3