Abstract
Case Presentation: A 41-year-old female presented with a 4-month history of right-sided nasal congestion and copious clear drainage. Her symptoms were attributed to seasonal allergies and treated with intranasal glucocorticoids and decongestants. Despite medical therapy, her symptoms persisted, and a computed tomography scan of the sinuses was obtained. Imaging demonstrated a fluid-attenuating lesion extending through the sellar region and into the right sphenoid sinus and nasopharynx via a skull base osseous defect (Fig. 1 A and B). Beta-2 transferrin testing of her rhinorrhea sample was positive, reflecting a cerebrospinal fluid (CSF) leak. Magnetic resonance imaging of the brain confirmed the presence of a pseudomeningocele advancing through the sellar region into the right nasal cavity (Fig. 1 C), with resultant partially empty sella, flattening of the posterior sclera, and prominent fluid-filled optic nerve sheaths. No clinical or biochemical evidence of pituitary dysfunction was noted on further evaluation. Lumbar puncture was performed and notable for an opening pressure of 34 cm of water. What is the diagnosis?
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