She reported that the rhinorrhea was worse in the morning and that she could feel the fluid spread down her throat while upright. She never experienced an episode like this in the past, but did report intermittent clear, thin liquid leaking through the right side of her nose for the past 15 months. To the best of our knowledge, this is the first case reported in the literature of a spontaneous CSF leak secondary to a defect in the posterior-inferior clival wall in a patient with an atypical BMI of <25 kg/m 2.Ī 54-year-old female with no prior history of surgery or trauma presented to the emergency department with a chief complaint of severe headache for the past two days. In the present study, we present a rare case of primary spontaneous CSF leak in a 54-year-old female with a negative prior β2-transferrin assay. In the largest study to date of 105 patients, the most likely sites for CSF leak included the cribriform plate (51%), sphenoid lateral pterygoid recess (31%), and ethmoid roof (8%). In a retrospective case series of 56 individuals with spontaneous CSF leaks, the most common bony defects were found in the lateral sphenoid sinus (41%), ethmoid roof (30%), cribriform plate (21%), central sphenoid (12.5%), and frontal sinuses (12.5%). Several small retrospective reviews determined the cribriform plate or ethmoid roof as the most common locations for defect. In a case series of six patients with clival CSF leaks, all defects were found to be in the superior, midline area of the clivus. There are conflicting reports regarding the location of the bony defect causing spontaneous CSF leak. This phenomenon has led to some positing a possible relationship between idiopathic intracranial hypertension (IIH) and primary spontaneous CSF leak. Additionally, many of these patients present with elevated intracranial pressures, with opening CSF pressures being between 25 and 27 cmH 2O. Although the underlying etiology behind spontaneous CSF leaks is poorly understood, the majority of patients are middle-aged or older females with elevated BMIs. This is of particular significance when considering that the mortality of bacterial meningitis may be as high as 15% in the United States. Due to the rare occurrence of spontaneous CSF leaks, accurate diagnoses and treatment are often delayed. Although the most common causes of CSF leak include trauma (80%) and iatrogenic injury (16%), around 5 per 10,000 people experience spontaneous CSF leaks each year. Accumulated CSF in the paranasal sinuses may serve as a nidus for retrograde microorganism transport through defects in the skull base. Cerebrospinal fluid (CSF) leaks have been well established as a risk factor for bacterial meningitis.
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