Hi! 14 years back my mother was diagnosed of Spontaneous non-traumatic CSF Rhinorrea. Following this she had an extracranial endoscopic surgery which only lasted for 6 months after which the leak reappeared. Therefore, doctors decided to do a intracranial surgery and after 14 years now she has again been diagnosed of CSF Rhinorrea. This time also it seems spontaneous as no trauma seems to have occurred. She is now 59 years old and we are afraid that another intracranial surgery at this age might be too risky and painful for her. Please advise on the best course of action in your opinion.
Currently, the doctors have advised her to take 7 days be rest as a part of conservative treatment following which they want to do a CT Cisternography test and also want to check the fluid pressure (ICP) as they doubt that may be high pressure may be causing the Rhinorrea to recur. Currently she is on bed rest and given a tablet called "Gardenal". During this period she complains of body ache and stiff neck. Please do let me know what do you think of her condition and if body ache is a normal symptom in such a condition.
Well, certainly jumping into an intracranial surgery is a bit too quick, so starting with a check of the fluid pressure, at the same time they do the CT cisternography would be helpful.
Testing the CSF for evidence of infection would also be important, since a stiff neck could be a sign of a spinal fluid infection (which would be important to treat quickly, if that is the case). CSF rhinorrhea is a risk factor for these infections. Body ache is not a normal symptom, so I would discuss that with her doctoros.
After pinpointing the area of the leak, my first inclination would be to try and repair the leak from "below" -- meaning endoscopically through the nose, with the ENT doctor. Of course, much of this depends on the location of the leak, and the anatomy of the area (whether or not there is scar tissue, what the brain appears to look like over this area, etc).
Thanks Dr. Mark! She did not have the stiffness before she started the bed rest. Considering that this time the diagnoses hapened pretty fast as she had prior experience and the doctors staryed the antibiotic as soon as the leak was tested csf positibve, wont this have abated the chances of the infection to a gteat extent. Can this be due to medicine's side reaction or probablu due to lack of sodium due to medicine consumption?
If they are treating her with antibiotics, that makes an infection less likely. Infection would also typically come with other symptoms, such as mental status changes like confusion, and fever as well.
It could be a side effect of the medication, or low sodium, as you mention. There are many potential reasons, which unfortunately can't be diagnosed over the Internet. It could also simply be because she is stuck in bed for an extended period of time.