Spontaneous Cerebrospinal Fluid Rhinorrhea as a Presenting Symptom of Aqueductal Stenosis -Case Report-

Abstract

A 30-year-old male patient presented with chronic spontaneous cerebrospinal fluid (CSF) rhinorrhea. He had sustained a mild head injury in childhood. Magnetic resonance imaging of the brain showed aqueductal stenosis associated with moderate supratentorial hydrocephalus, and erosion of the cribriform plate. Following insertion of ventriculoperitoneal shunt, the CSF rhinorrhea completely ceased and no direct repair of the CSF fistula was necessary. Long-standing spontaneous CSF rhinorrhea indicates the possibility of concurrent intracranial pathology, such as aqueductal stenosis.

Symptomatic spontaneous pneumocephalus after spinal fusion for spondylolisthesis

“…5 Many other occult anatomic anomalies have also been detected in the anterior cranial base. [6][7][8] Any thing that increases the intracranial pressure might open any already present occult anatomic defect.…”

“…1,3,4 Other locations (tentorium, convexity, anterior cranial fossa, cerebellopontine angle, Meckel's cave, sella turcica, internal auditory meatus or related to cranial nerves) are rarer, and only about 20 reports have been published. [3][4][5][6][7][8][9][10][11][12] Differential diagnosis includes other extra-axial enhancing tumours, mainly meningiomas.…”

Delayed pneumocephalus following shunting for hydrocephalus

“…2,10,12,14,16 Thinning of the skull base is well-described in aqueduct stenosis, and patients with this condition form a significant proportion of those who develop post-shunting pneumocephalus. 2,3,[7][8][9]13,[18][19][20] Although spontaneous CSF leakage has been reported as a presenting feature of aqueduct stenosis, 6,21 in most cases the defect is presumably completely plugged by meningeal scarring or gliotic brain tissue. Significant lowering of intracranial pressure following shunting causes the fistula to become patent and results in pneumocephalus.…”

Ethmoidal meningoencephalocele and CSF leak after posthaemorrhagic ventricular dilatation in a newborn child

“…Occasionally, high-pressure hydrocephalus caused by long-standing increased intracranial pressure (ICP) itself has been the cause of rhinoliquorrhoea in adults [24], presumably secondary to the chronically raised ICP with skull base erosion and meningocele. Aqueductal stenosis has also been involved in the pathophysiology, with moderate supratentorial hydrocephalus and erosion of the cribriform plate [2,14,27]. Though CSF leak may occasionally mean patients with idiopathic intracranial hypertension remain symptom-free, symptoms of elevated ICP may appear after a CSF leak is repaired, thereby exposing these patients to a high risk of recurrence of the leak unless an ICP-lowering intervention is performed.…”