Spontaneous “High-Pressure Cerebrospinal Rhinorrhea” Due to Lesions Obstructing Flow of Cerebrospinal Fluid

Spontaneous Cerebrospinal Fluid Rhinorrhea as the Primary Manifestation of Maxillary Carcinoma-Case Report-

“…The variation in the CSF flow dynamics at the tumor-arachnoid interface may accentuate tumor growth and expansion. 16) The fairly large size attained by the tumor in a relatively short period, as in our case, may have been related to the persistent spontaneous CSF rhinorrhea, which was normal pressure CSF rhinorrhea as there was no obstruction to the ventricular or subarachnoid pathways.…”

“…1,9) The cribriform plate is a relatively`weak site' allowing transmission of the CSF from the intracranial region to the nasal cavity, presumably related to constitutional or developmental factors including a persistent craniopharyngeal canal, a fistula in the retained embryonic lumen of the olfactory bulb, incompletely occluded holes around the olfactory nerves in the cribriform plate, or meningeal dysplasia in the region of the olfactory nerve. 1,3,9,15,16) Any incident increasing intracranial pressure suddenly, such as sneezing or coughing, could force open an otherwise obscure anatomical defect and allow CSF leakage. 13) Erosion of the cribriform plate and CSF rhinorrhea are indicators of malignant potential and aggressive nature of the tumor.…”

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

“…Three cases of aqueductal stenosis have been reported manifesting as a fistulous communication between the protruding frontal lobe and the defect in the cribriform plate. 19,28,29) A case of aqueductal stenosis presented with spontaneous CSF rhinorrhea associated with a empty sella syndrome. 13) Three cases of spontaneous CSF rhinorrhea associated with aqueductal stenosis were managed by insertion of a ventriculoperitoneal shunt and resulted in intraventricular tension pneumocephalus.…”

“…9,21) Several benign and malignant intracranial tumors have also been reported to cause CSF rhinorrhea. 12,18,28,31) Spontaneous CSF rhinorrhea is leakage of fluid from the subarachnoid space to the frontal, sphenoidal, or ethmoidal sinuses.``Indirect or hypertensive spontaneous rhinorrhea'' suggests that CSF fistula is possible only if hydrocephalus coexists with a congenital abnormality of the cranial base. 1,4,23) Spontaneous CSF rhinorrhea associated with aqueductal stenosis can occur in various ways.…”

“…Spontaneous CSF rhinorrhea is uncommon as a primary presenting feature of aqueductal stenosis, with only nine reported cases. 3,10,11,13,14,19,[28][29][30] The treatment of these cases has varied widely. We report an adult case of aqueductal stenosis manifesting as spontaneous CSF rhinorrhea probably originating from dehiscence of the cribriform plate following head trauma in childhood.…”