36 Cerebrospinal Fluid Rhinorrhoea • Spontaneous—may be associated with benign intracranial hypertension • Iatrogenic (see Chapter 27) • Trauma • Infectious/inflammatory—erosive sinonasal disease (see Chapters 25 and 26) • Neoplastic • Unknown aetiology that predominantly affects obese women of childbearing age • Incidence of 0.9 to 1.0 per 100,000 in the general population • Key features: • The diagnostic criteria: • Diagnostic steps:
36.1 Aetiology of Cerebrospinal Fluid Rhinorrhoea
36.2 Benign (Idiopathic) Intracranial Hypertension
1.6 to 3.5 per 100,000 in women
7.9 to 20 per 100,000 in women who are overweight
Chronically elevated ICP
Papilledema present, which may lead to progressive optic atrophy and blindness
Symptoms and signs of increased ICP
No localizing neurological signs (with the exception of a unilateral or bilateral CN VI paresis)
Cerebrospinal fluid (CSF) may show increased pressure, but there are no cytologic or chemical abnormalities
Normal to small symmetric ventricles must be demonstrated
Lumbar puncture (LP) should be done with the patient in the lateral decubitus position. Lumbar puncture is performed to measure the opening pressure, as well as to obtain CSF to exclude alternative diagnoses
MRI or venography should be included to rule out intracranial venous sinus thromboses
Other causes of intracranial hypertension should be ruled out
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