Spinal fluid draining out of nose—Causes? Side effects?

Dear Alice,

My daughter's friend was having this problem I have never heard of: she had spinal fluid draining out of the nose. What causes this? Is it serious and what are the side effects from the drainage?

Dear Reader, 

What you have described may be caused by a cerebrospinal fluid (CSF)—protective liquid that coats your brain and spinal cord—leak, more specifically CSF rhinorrhea. CSF rhinorrhea is a condition where CSF leaks out through a tear in the dura mater—the layer of tough, fibrous tissue surrounding the brain and spinal cord. The leaking fluid then enters the upper part of the throat behind your nose and exits through the nose or ears. Researchers believe that trauma to the head or certain surgeries might break or weaken the dura mater resulting in the tear that would allow a leak to occur. Other potential causes of cranial CSF leaks include a brain tumor, obesity, or intracranial hypertension (high pressure around the brain), infections (especially those in the ear canal, sinus cavities, and eyes), blood clots, and embolisms as they may erode the dura mater and make it susceptible to ripping. While there are several potential reasons why the dura mater might rip or get punctured, in other instances, the cause of this condition can be difficult to determine. 

Symptoms of cerebrospinal fluid rhinorrhea can begin to appear at various times. For those who experience head trauma or undergo surgery, symptoms may arise within as few as 48 hours or as late as three months later. The type of symptoms as well as their intensity can also vary depending on how much pressure the leak puts on the brain. Common effects of the condition are headaches, dizziness, tinnitus (the feeling of ringing ears), congestion, nausea, and a stiff neck. Other more severe symptoms can include seizures, blurred vision, and hearing loss. 

One of the more life-threatening effects of CSF rhinorrhea, however, is the ease with which infection can spread. Because of the open tear in the dura mater, microbe or bacterium found in your nose or the back of your throat could easily flow into the broken tissue and begin to multiply around the brain or spinal cord. This could lead to the potentially serious condition of meningitis in which the tissue around the brain swells. A second life-threatening complication from the leak is called tension pneumocephalus—though rare, it’s a condition that occurs when air is pulled into the dura mater. This leads to the space around the brain becoming compressed, resulting in neurological dysfunction or even death. 

While more serious CSF leaks may need to be treated with medication or surgery, CSF rhinorrhea often heals on its own with a short period of bed rest.  In the case of tension pneumocephalus, the air in the dura mater can also be removed. 

Here’s to hoping for a speedy and full recovery for your daughter’s friend. 

Last updated May 05, 2023
Originally published Oct 17, 2014

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