Non-Traumatic Cerebrospinal Fluid Leak from a Sphenoid Sinus Midline Roof Defect Previously Managed as Allergic Rhinitis

Abstract

Objective: To present a case of a non-traumatic cerebrospinal fluid (CSF) rhinorrhea from a midline sphenoid sinus roof that presented as a persistent postnasal drip and was previously managed as allergic rhinitis for 43 years.
 
 Methods:
 Design: Case Report
 Setting: Tertiary Private University Hospital
 Participants: One
 
 Results: A 58-year-old obese and hypertensive man presented with persistent post nasal drip and intermittent clear watery rhinorrhea. He had been managed as a case of allergic rhinitis for 43 years and was maintained on nasal steroid sprays without relief. Nasal endoscopy revealed pulsating clear watery discharge from the sphenoid ostium. On trans-sphenoidal surgery, a midline sphenoid sinus roof defect was sealed using a Hadad-Bassagasteguy flap.
 
 Conclusion: CSF rhinorrhea is uncommon and may mimic more common diseases such as allergic rhinitis. Because misdiagnosis can then lead to life threatening complications, physicians should be vigilant when seeing patients with clear watery rhinorrhea to be able to arrive at a proper diagnosis and provide prompt treatment.
 
 Keywords: cerebrospinal fluid rhinorrhea; cerebrospinal fluid leak; sphenoid sinus midline roof defect