A Case of Recurrent Spontaneous CSF Rhinorrhoea with Meningoencephalitis

Abstract

Cerebrospinal fluid (CSF) rhinorrhoea is the leakage of CSF from the subarachnoid space into the nasal cavity. A cerebrospinal fluid leak from intracranial cavity to nasal respiratory tract has the potential to produce fulminant meningitis because of the risk of an ascending infection. Recurrent spontaneous CSF rhinorrhoea is definitely a life-threatening entity that can be preventable with timely intervention. This case report describes the clinical course of a 51 year old obese female with recurrent episodes of spontaneous CSF rhinorrhoea presenting with high grade fever, vomiting, headache and new-onset seizure. She was evaluated for meningoencephalitis and CSF culture revealed growth of Staphylococcus arlettae. Patient improved with ceftriaxone, vancomycin and levetiracetam and was advised for early surgical repair. A longer duration of nasal discharge of CSF has greater risk of morbidity/mortality due to ascending CNS infection. The episodes of spontaneous CNS rhinorrhoea can pass by unnoticed and can also be missed for rhinosinusitis. A high suspicion of diagnosis can lead to early detection of this condition and better outcome. Treatment decisions should be dictated by the severity of neurological decline during the emergency period and the presence/absence of associated intracranial lesions. The emphasis for timely surgical repair should be advocated for better outcome.