The man with a persistently runny nose

Area of Science:

• Neurology
• Emergency Medicine
• Otolaryngology

Background:

• Cerebrospinal fluid (CSF) rhinorrhea is a rare condition, typically associated with trauma.
• Spontaneous CSF leaks, often linked to intracranial hypertension, pose a diagnostic challenge in emergency settings.
• Delayed diagnosis of CSF leaks can lead to severe complications, including meningitis.

Observation:

• This case report details a patient presenting with persistent, unilateral rhinorrhea and headache, initially misdiagnosed.
• The patient experienced a spontaneous cerebrospinal fluid leak, unrelated to any traumatic event.
• The presentation mimicked other conditions, highlighting the need for a high index of suspicion.

Findings:

• The case underscores the importance of considering atraumatic CSF rhinorrhea in the differential diagnosis for persistent, unilateral rhinorrhea.
• Diagnostic modalities for CSF leaks were reviewed in the context of this unusual presentation.
• Successful diagnosis and management were achieved, preventing further complications.

Implications:

• Emergency physicians must be aware of spontaneous CSF leaks as a potential cause of atraumatic rhinorrhea.
• Prompt recognition and management of CSF leaks are essential to mitigate morbidity and mortality.
• This case contributes to the understanding of rare manifestations of CSF leaks and their emergency department diagnosis.