CSF rhinorrhoea from encephalocolele secondary to pseudotumour cerebri

Case contributed by A.Prof Frank Gaillard

Presentation

Intermittent fluid from nose.

Patient Data

Age: 50 years
Gender: Female

A bony defect is present through the ventromedial aspect of the right middle cranial fossa, through which meninges and distorted brain protrude (meningoencephalocoele), into the lateral aspect of the right side of the sphenoid sinus. 

Ancillary findings of intracranial hypertension are also present: empty pituitary fossa, prominent optic nerve sheaths and bilateral distal transverse sinus stenosis. 

A bony defect is present through the ventromedial aspect of the middle cranial fossa on the right with soft tissue attenuating tissue protruding into the sphenoid sinus. 

Case Discussion

This is a classic constellation of findings. A middle aged female with features of intracranial hypertension (pseudotumour cerebri) develops multiple areas of medial sphenoid (middle cranial fossa) scalloping. Eventually one results in a meningocoele or meningoencephalocoele and ruptures into the sphenoid sinus resulting in CSF rhinorrhea

In many instances the prior elevated intracranial pressures have not been symptomatic or recognised and symptoms become more acute following CSF leak repair (suggesting that the leak was a form of 'self treatment'). 

The patient went on to have endoscopic repair of the defect at which time CSF was noted to be under unusually high pressures. 

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Case information

rID: 43086
Case created: 23rd Feb 2016
Last edited: 25th Feb 2016
Inclusion in quiz mode: Included

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