Rhinorrea in Emergency: on a case
The rhinorrhea is the segregation and subsequent expulsion of fluid through the nasal passages that is formed in the nasal and paranasal mucosa. This liquid is formed mainly by water in a percentage of 97% and the rest salts such as mucin and albumin.
The rhinorrhea can be produced by different causes being the most prevalent in the community the colds triggered by a viral infection or acute rhinitis.
Other causes that can also trigger this symptom are nasal polyps, allergies, nasal tumors, inflammation of the paranasal sinus and inhalation of irritants.
In order to diagnose the etiology of the problem, a good anamnesis is necessary, to evaluate liquid characteristics and a rhinoscopy.
We present the case of a male patient of 51 years of age, who is referred to the emergency department for presenting one year before, spontaneous expulsion of crystalline fluid intermittently, through the left nostril. The patient had no history of cranio-facial trauma or rhinological interventions. The patient had received treatment for suspected allergic rhinitis without improvement.
In the physical examination he is made to perform the Valsalva maneuver, increasing the expulsion of fluid through the nasal fossa. We collect sample of the liquid and check if it has glucose in its composition. The glucose test was positive so it was suspected that the rhinorrhea was cerebrospinal fluid.
We performed a paranasal sinus scan, in which we objectified a bone defect in the lateral wall of the left sphenoid sinus, in contact with the temporal cerebral fossa.
With the diagnosis of spontaneous cerebrospinal fluid fistula, he was admitted to continue the study and perform the neurosurgical treatment.
Spontaneous cerebrospinal fluid fistulas have been attributed to congenital defects of the lamina cribosa of the ethmoid.
The rhinorrhea of cerebrospinal fluid results from the direct communication of the subarachnoid space and the upholstered space of nasal mucosa and paranasal sinuses.
