(A1112) Differentiation Between Spontaneous Cerebrospinal Fluid Rhinorrhea and General Rhinorrhea

Introduction: Spontaneous CSF rhinorrhea can be mistaken for general rhinorrhea, or a runny nose, leading to false diagnosis and prolonging symptoms. This study attempts to establish a diagnostic standard to better differentiate between spontaneous CSF and non-CSF rhinorrhea to improve early diagnosis rates and reduce the morbidity of CSF leaks.

Methods: Data was collected using Google Scholar and PubMed databases. Inclusion criteria encompassed case reports and case series on spontaneous CSF leak with rhinorrhea between 2014 and 2024. Patients were excluded if they had a history of trauma and prior nasal surgeries. A total of 128 patients met the inclusion criteria.

Results: One hundred and three patients (80.5%) were female and twenty-five (19.5%) were male. The average age of the patients was 46.1. Of the one hundred and thirteen patients (88.3%) with a recorded BMI index, the average was 32.2. Twenty-nine (22.7%) patients presented with headaches. Forty-three patients (33.6%) presented with empty sella syndrome. Sixty (46.9%) patients had a skull defect in the cribriform plate, eighteen (14.1%) in the ethmoid, twenty (15.6%) in the central sphenoid, seventeen (13.3%) in the sphenoid lateral recess, seven (5.5%) in the clivus, and two (1.6%) in the sphenoid-ethmoid region.

Conclusions: This case series supported previously suggested diagnostic criteria and analyzed “high risk” characteristics to expand the criterion. The major indicators of spontaneous CSF rhinorrhea should include (1) unilateral nasal leakage of clear fluid, (2) skull defects in the cribriform plate, ethmoid bone, sphenoid bone, or clivus, (3) empty sella syndrome, and (4) headaches. Additional indicators include (1) being female, (2) middle age or older, and (3) clinically overweight or obese (BMI ≥ 25).