SlideShare uma empresa Scribd logo
1 de 14
Baixar para ler offline
CSF rhinorrhea
CSF rhinorrhea 
• Leakage of CSF in to the nose 
• Clear / 
• mixed with blood (in a/c head injuries)
Etiology 
• Trauma (commonest) 
• Accidental 
• Surgical ( FESS, nasal polypectomy, trans sphenoidal hypophysectomy,skull 
base surgery) 
• Neoplasms (benign/malignant) invading skull base 
• Inflammations (mucocele of sinuses ,sinu nasal polyposis, fungal 
infections of sinusitis & osteomyelitis erode the bone & 
dura) 
• Congenital (meningocele,meningoencephalocele & glioma with skull 
base defect) 
• Idiopathic
Site of leakage 
1. anterior cranial fossa 
a) Cribriform plate 
b) Roof of ethmoid 
c) Frontal sinus 
2. Middle cranial fossa  
1. injuries to sphenoid sinus 
2. In # of temporal bone CSF ME ET nose (CSF otorhinorhea)
Diagnosis 
• h/o clear watery discharge on bending head/ straining 
• sudden gush can’t be sniffed back 
• Reservoir sign : 
• When rising in morning csf collected in sinuses on bending head
• After a head trauma 
• Double target sign when collected on a piece of filter paper with central 
blood & peripheral llighter halo
• Nasal endoscopy  localize site of CSF leak 
• Otoscopic /microscopic examination of ear } CSF otorrhinorhea
Csf rhinorrhea ppt
Laboratory tests 
• B2 transferrin 
• Sensitive & specific 
• Only few drops of csf is needed 
• Perilymph & aqueous also contains it but not in nasal discharge 
• Beta trace protein 
• Specific for CSF 
• Glucose testing 
• > 30 mg/dl in csf 
• <10 mg/dl in nasal discharge
Localisation of site 
• High resolution CT scan 
• Coronal & axial cuts at 1-2 mm } bony defects 
• Axial } frontal & sphenoid sinus 
• MRI 
• T2 weighted image Site of leak 
• Active CSF leak is needed 
• Non invasive
Treatment 
• Conservative 
• Bed rest 
• Elevating the head 
• Stool softeners 
• Avoidance of node blowing, sneezing & straining 
• Prophylatic abx } meningitis 
• Acetazolamide } ↓ formn of CSF
Surgical repair 
• Neurosurgical intra cranial approach 
• Extra dural approach 
• External ethmoidectomy } cribriform plate 
• Trans septal sphenoidal approach } sphenoid 
• Osteoplastic flap } frontal
• Trans nasal endoscopic approach 
• With endoscope 
• Site of leak 
1. Cribriform plate 
2. Lateral lamina close to anterior ethmoid a 
3. Roof of ethmoid 
4. Frontal sinus leak 
5. Sphenoid sinus 
• Preparation of graft site 
• Underlay placement of graft extra durally (mucosa for small defect….. Septal cartilage 
if>2cm) 
• Surgical & gelfoam strengthen 
• Lumbar drain if CSF pressure is high 
• abx
• Intrathecal fluorescein study 
• Pre operatively }to dx site 
• Intra operatively for repair 
• Invasive 
• 0.25-0.5 ml of 5% fluorescein mixed with patients own CSF is injected & pt lies in 10 ’ 
head down position for some time dye ca be detected intranasally with the help of 
endoscope……….appears bright yellow but when seen with blue filter } flurescent 
green 
• Localise the lesion 
• CT cisternogram 
• Localise the lesion 
• Intrathecal injection of iohexol & CT 
• Where B2 transferrin can’t be done

Mais conteúdo relacionado

Mais procurados

Cortical mastoidectomy
Cortical mastoidectomy Cortical mastoidectomy
Cortical mastoidectomy Mamoon Ameen
 
Maxillary sinus carcinoma
Maxillary sinus carcinomaMaxillary sinus carcinoma
Maxillary sinus carcinomaHarsha Yadav
 
Juvenile nasopharyngeal angiofibroma
Juvenile nasopharyngeal angiofibromaJuvenile nasopharyngeal angiofibroma
Juvenile nasopharyngeal angiofibromapraneeth koduru
 
Cavernous sinus thrombosis
Cavernous sinus thrombosisCavernous sinus thrombosis
Cavernous sinus thrombosisNeurologyKota
 
Complications of csom
Complications of csomComplications of csom
Complications of csomAjay Manickam
 
Tympanoplasty; Indications, types, anesthesia, surgical procedure.
Tympanoplasty; Indications, types, anesthesia, surgical procedure.Tympanoplasty; Indications, types, anesthesia, surgical procedure.
Tympanoplasty; Indications, types, anesthesia, surgical procedure.Prasanna Datta
 
Clinical anatomy of facial nerve and facial nerve palsy
Clinical anatomy of facial nerve and facial nerve palsy Clinical anatomy of facial nerve and facial nerve palsy
Clinical anatomy of facial nerve and facial nerve palsy Ramesh Parajuli
 
SURGICAL ANATOMY OF DEEP NECK SPACES
SURGICAL ANATOMY OF DEEP NECK SPACESSURGICAL ANATOMY OF DEEP NECK SPACES
SURGICAL ANATOMY OF DEEP NECK SPACESAjay Manickam
 
Ranula and plunging ranula
Ranula and plunging ranulaRanula and plunging ranula
Ranula and plunging ranulaArunachalam L
 
Facial nerve injury and reanimation
Facial nerve injury and reanimationFacial nerve injury and reanimation
Facial nerve injury and reanimationMohammed Rhael
 

Mais procurados (20)

Cortical mastoidectomy
Cortical mastoidectomy Cortical mastoidectomy
Cortical mastoidectomy
 
Maxillary sinus carcinoma
Maxillary sinus carcinomaMaxillary sinus carcinoma
Maxillary sinus carcinoma
 
Caldwell luc surgery
Caldwell luc surgeryCaldwell luc surgery
Caldwell luc surgery
 
Juvenile nasopharyngeal angiofibroma
Juvenile nasopharyngeal angiofibromaJuvenile nasopharyngeal angiofibroma
Juvenile nasopharyngeal angiofibroma
 
Ranula
RanulaRanula
Ranula
 
Cavernous sinus thrombosis
Cavernous sinus thrombosisCavernous sinus thrombosis
Cavernous sinus thrombosis
 
Myringoplasty ppt
Myringoplasty pptMyringoplasty ppt
Myringoplasty ppt
 
Complications of csom
Complications of csomComplications of csom
Complications of csom
 
Tympanoplasty; Indications, types, anesthesia, surgical procedure.
Tympanoplasty; Indications, types, anesthesia, surgical procedure.Tympanoplasty; Indications, types, anesthesia, surgical procedure.
Tympanoplasty; Indications, types, anesthesia, surgical procedure.
 
Clinical anatomy of facial nerve and facial nerve palsy
Clinical anatomy of facial nerve and facial nerve palsy Clinical anatomy of facial nerve and facial nerve palsy
Clinical anatomy of facial nerve and facial nerve palsy
 
Tympanoplasty
TympanoplastyTympanoplasty
Tympanoplasty
 
SURGICAL ANATOMY OF DEEP NECK SPACES
SURGICAL ANATOMY OF DEEP NECK SPACESSURGICAL ANATOMY OF DEEP NECK SPACES
SURGICAL ANATOMY OF DEEP NECK SPACES
 
Cervical lymph nodes
Cervical lymph nodesCervical lymph nodes
Cervical lymph nodes
 
Ranula
RanulaRanula
Ranula
 
Fess
FessFess
Fess
 
Parotidectomy
ParotidectomyParotidectomy
Parotidectomy
 
Mastoidectomy
MastoidectomyMastoidectomy
Mastoidectomy
 
JNA
JNAJNA
JNA
 
Ranula and plunging ranula
Ranula and plunging ranulaRanula and plunging ranula
Ranula and plunging ranula
 
Facial nerve injury and reanimation
Facial nerve injury and reanimationFacial nerve injury and reanimation
Facial nerve injury and reanimation
 

Semelhante a Csf rhinorrhea ppt

Jugular foramen anatomy and approaches
Jugular foramen anatomy and approachesJugular foramen anatomy and approaches
Jugular foramen anatomy and approachesDikpal Singh
 
Endoscopic skull base surgery level iii
Endoscopic skull base surgery level iiiEndoscopic skull base surgery level iii
Endoscopic skull base surgery level iiilpgupta
 
Maxillofacial injury
Maxillofacial injuryMaxillofacial injury
Maxillofacial injuryDennis Lee
 
Frontal sinus surgeries
Frontal sinus surgeriesFrontal sinus surgeries
Frontal sinus surgeriesTabeer Arif
 
Diseases of the nasal septum
Diseases of the nasal septumDiseases of the nasal septum
Diseases of the nasal septumAnwaaar
 
Nasal septum & septoplasty
Nasal  septum & septoplastyNasal  septum & septoplasty
Nasal septum & septoplastyDr Soumya Singh
 
Nasal bone fracture
Nasal bone fractureNasal bone fracture
Nasal bone fractureahmedaan84
 
ANATOMY OF NOSE AND PARANASAL SINUSES.pptx
ANATOMY OF NOSE AND PARANASAL SINUSES.pptxANATOMY OF NOSE AND PARANASAL SINUSES.pptx
ANATOMY OF NOSE AND PARANASAL SINUSES.pptxsubrat0002
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitiskrishnakoirala4
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitiskrishnakoirala4
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitiskrishnakoirala4
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitiskrishnakoirala4
 
Endoscopic Endonasal Anatomy.pptx
Endoscopic Endonasal Anatomy.pptxEndoscopic Endonasal Anatomy.pptx
Endoscopic Endonasal Anatomy.pptxDr. Rahul Jain
 

Semelhante a Csf rhinorrhea ppt (20)

Jugular foramen anatomy and approaches
Jugular foramen anatomy and approachesJugular foramen anatomy and approaches
Jugular foramen anatomy and approaches
 
Endoscopic skull base surgery level iii
Endoscopic skull base surgery level iiiEndoscopic skull base surgery level iii
Endoscopic skull base surgery level iii
 
Nasal and noe fractures
Nasal and noe fracturesNasal and noe fractures
Nasal and noe fractures
 
CSF Rhinorrhea
CSF Rhinorrhea CSF Rhinorrhea
CSF Rhinorrhea
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitis
 
Maxillofacial injury
Maxillofacial injuryMaxillofacial injury
Maxillofacial injury
 
Frontal sinus surgeries
Frontal sinus surgeriesFrontal sinus surgeries
Frontal sinus surgeries
 
Diseases of the nasal septum
Diseases of the nasal septumDiseases of the nasal septum
Diseases of the nasal septum
 
Nasal septum & septoplasty
Nasal  septum & septoplastyNasal  septum & septoplasty
Nasal septum & septoplasty
 
Rhinoplasty
RhinoplastyRhinoplasty
Rhinoplasty
 
Nasal bone fracture
Nasal bone fractureNasal bone fracture
Nasal bone fracture
 
ANATOMY OF NOSE AND PARANASAL SINUSES.pptx
ANATOMY OF NOSE AND PARANASAL SINUSES.pptxANATOMY OF NOSE AND PARANASAL SINUSES.pptx
ANATOMY OF NOSE AND PARANASAL SINUSES.pptx
 
Parotid surgeries
Parotid surgeriesParotid surgeries
Parotid surgeries
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitis
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitis
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitis
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitis
 
Endoscopic Endonasal Anatomy.pptx
Endoscopic Endonasal Anatomy.pptxEndoscopic Endonasal Anatomy.pptx
Endoscopic Endonasal Anatomy.pptx
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitis
 
CSF RHINORRHOEA
CSF RHINORRHOEACSF RHINORRHOEA
CSF RHINORRHOEA
 

Mais de TONY SCARIA

Phosphorus metabolism
Phosphorus metabolism Phosphorus metabolism
Phosphorus metabolism TONY SCARIA
 
Osteoporosis clinical features and management
Osteoporosis clinical features and management Osteoporosis clinical features and management
Osteoporosis clinical features and management TONY SCARIA
 
Calcium METABOLISM
Calcium METABOLISM Calcium METABOLISM
Calcium METABOLISM TONY SCARIA
 
Magnesium metabolism
Magnesium metabolism Magnesium metabolism
Magnesium metabolism TONY SCARIA
 
Special senses physiology revison topics
Special senses physiology revison topics Special senses physiology revison topics
Special senses physiology revison topics TONY SCARIA
 
CSF PHYSIOLOGY ANALYSIS NORMAL AND DISEASE
CSF PHYSIOLOGY ANALYSIS NORMAL AND DISEASE CSF PHYSIOLOGY ANALYSIS NORMAL AND DISEASE
CSF PHYSIOLOGY ANALYSIS NORMAL AND DISEASE TONY SCARIA
 
Deep neck space infection ENT REVISION NOTES
Deep neck space infection ENT REVISION NOTES Deep neck space infection ENT REVISION NOTES
Deep neck space infection ENT REVISION NOTES TONY SCARIA
 
Antirheumatic drugs &amp; anti gout drugs PHARMACOLOGY REVISION NOTES
Antirheumatic drugs &amp; anti gout drugs PHARMACOLOGY REVISION NOTES Antirheumatic drugs &amp; anti gout drugs PHARMACOLOGY REVISION NOTES
Antirheumatic drugs &amp; anti gout drugs PHARMACOLOGY REVISION NOTES TONY SCARIA
 
Trauma to eye REVISION NOTES
Trauma to eye REVISION NOTES Trauma to eye REVISION NOTES
Trauma to eye REVISION NOTES TONY SCARIA
 
Orbit OPHTHALMOLOGY REVISION NOTES
Orbit OPHTHALMOLOGY REVISION NOTES Orbit OPHTHALMOLOGY REVISION NOTES
Orbit OPHTHALMOLOGY REVISION NOTES TONY SCARIA
 
Vision 2020 REVISION NOTES
Vision 2020 REVISION NOTES Vision 2020 REVISION NOTES
Vision 2020 REVISION NOTES TONY SCARIA
 
Cataract revisionnotes ophthalmology
Cataract revisionnotes ophthalmology  Cataract revisionnotes ophthalmology
Cataract revisionnotes ophthalmology TONY SCARIA
 
Uvea ophthalmology revision notes
Uvea ophthalmology revision notesUvea ophthalmology revision notes
Uvea ophthalmology revision notesTONY SCARIA
 
Retinoblastoma revision notes
Retinoblastoma revision notes Retinoblastoma revision notes
Retinoblastoma revision notes TONY SCARIA
 
Genetics pathology revision notes
Genetics pathology revision notes Genetics pathology revision notes
Genetics pathology revision notes TONY SCARIA
 
Cell injury pathology revision notes
Cell injury pathology revision notes Cell injury pathology revision notes
Cell injury pathology revision notes TONY SCARIA
 

Mais de TONY SCARIA (20)

Mucormycosis
MucormycosisMucormycosis
Mucormycosis
 
Phosphorus metabolism
Phosphorus metabolism Phosphorus metabolism
Phosphorus metabolism
 
cbc Histogram
cbc Histogramcbc Histogram
cbc Histogram
 
Osteoporosis clinical features and management
Osteoporosis clinical features and management Osteoporosis clinical features and management
Osteoporosis clinical features and management
 
Calcium METABOLISM
Calcium METABOLISM Calcium METABOLISM
Calcium METABOLISM
 
Magnesium metabolism
Magnesium metabolism Magnesium metabolism
Magnesium metabolism
 
Special senses physiology revison topics
Special senses physiology revison topics Special senses physiology revison topics
Special senses physiology revison topics
 
CSF PHYSIOLOGY ANALYSIS NORMAL AND DISEASE
CSF PHYSIOLOGY ANALYSIS NORMAL AND DISEASE CSF PHYSIOLOGY ANALYSIS NORMAL AND DISEASE
CSF PHYSIOLOGY ANALYSIS NORMAL AND DISEASE
 
Plantar reflex
Plantar reflexPlantar reflex
Plantar reflex
 
Dna viruses
Dna virusesDna viruses
Dna viruses
 
Deep neck space infection ENT REVISION NOTES
Deep neck space infection ENT REVISION NOTES Deep neck space infection ENT REVISION NOTES
Deep neck space infection ENT REVISION NOTES
 
Antirheumatic drugs &amp; anti gout drugs PHARMACOLOGY REVISION NOTES
Antirheumatic drugs &amp; anti gout drugs PHARMACOLOGY REVISION NOTES Antirheumatic drugs &amp; anti gout drugs PHARMACOLOGY REVISION NOTES
Antirheumatic drugs &amp; anti gout drugs PHARMACOLOGY REVISION NOTES
 
Trauma to eye REVISION NOTES
Trauma to eye REVISION NOTES Trauma to eye REVISION NOTES
Trauma to eye REVISION NOTES
 
Orbit OPHTHALMOLOGY REVISION NOTES
Orbit OPHTHALMOLOGY REVISION NOTES Orbit OPHTHALMOLOGY REVISION NOTES
Orbit OPHTHALMOLOGY REVISION NOTES
 
Vision 2020 REVISION NOTES
Vision 2020 REVISION NOTES Vision 2020 REVISION NOTES
Vision 2020 REVISION NOTES
 
Cataract revisionnotes ophthalmology
Cataract revisionnotes ophthalmology  Cataract revisionnotes ophthalmology
Cataract revisionnotes ophthalmology
 
Uvea ophthalmology revision notes
Uvea ophthalmology revision notesUvea ophthalmology revision notes
Uvea ophthalmology revision notes
 
Retinoblastoma revision notes
Retinoblastoma revision notes Retinoblastoma revision notes
Retinoblastoma revision notes
 
Genetics pathology revision notes
Genetics pathology revision notes Genetics pathology revision notes
Genetics pathology revision notes
 
Cell injury pathology revision notes
Cell injury pathology revision notes Cell injury pathology revision notes
Cell injury pathology revision notes
 

Último

Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectiondrhanifmohdali
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfDolisha Warbi
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 

Último (20)

Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissection
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 

Csf rhinorrhea ppt

  • 2. CSF rhinorrhea • Leakage of CSF in to the nose • Clear / • mixed with blood (in a/c head injuries)
  • 3. Etiology • Trauma (commonest) • Accidental • Surgical ( FESS, nasal polypectomy, trans sphenoidal hypophysectomy,skull base surgery) • Neoplasms (benign/malignant) invading skull base • Inflammations (mucocele of sinuses ,sinu nasal polyposis, fungal infections of sinusitis & osteomyelitis erode the bone & dura) • Congenital (meningocele,meningoencephalocele & glioma with skull base defect) • Idiopathic
  • 4. Site of leakage 1. anterior cranial fossa a) Cribriform plate b) Roof of ethmoid c) Frontal sinus 2. Middle cranial fossa  1. injuries to sphenoid sinus 2. In # of temporal bone CSF ME ET nose (CSF otorhinorhea)
  • 5. Diagnosis • h/o clear watery discharge on bending head/ straining • sudden gush can’t be sniffed back • Reservoir sign : • When rising in morning csf collected in sinuses on bending head
  • 6. • After a head trauma • Double target sign when collected on a piece of filter paper with central blood & peripheral llighter halo
  • 7. • Nasal endoscopy  localize site of CSF leak • Otoscopic /microscopic examination of ear } CSF otorrhinorhea
  • 9. Laboratory tests • B2 transferrin • Sensitive & specific • Only few drops of csf is needed • Perilymph & aqueous also contains it but not in nasal discharge • Beta trace protein • Specific for CSF • Glucose testing • > 30 mg/dl in csf • <10 mg/dl in nasal discharge
  • 10. Localisation of site • High resolution CT scan • Coronal & axial cuts at 1-2 mm } bony defects • Axial } frontal & sphenoid sinus • MRI • T2 weighted image Site of leak • Active CSF leak is needed • Non invasive
  • 11. Treatment • Conservative • Bed rest • Elevating the head • Stool softeners • Avoidance of node blowing, sneezing & straining • Prophylatic abx } meningitis • Acetazolamide } ↓ formn of CSF
  • 12. Surgical repair • Neurosurgical intra cranial approach • Extra dural approach • External ethmoidectomy } cribriform plate • Trans septal sphenoidal approach } sphenoid • Osteoplastic flap } frontal
  • 13. • Trans nasal endoscopic approach • With endoscope • Site of leak 1. Cribriform plate 2. Lateral lamina close to anterior ethmoid a 3. Roof of ethmoid 4. Frontal sinus leak 5. Sphenoid sinus • Preparation of graft site • Underlay placement of graft extra durally (mucosa for small defect….. Septal cartilage if>2cm) • Surgical & gelfoam strengthen • Lumbar drain if CSF pressure is high • abx
  • 14. • Intrathecal fluorescein study • Pre operatively }to dx site • Intra operatively for repair • Invasive • 0.25-0.5 ml of 5% fluorescein mixed with patients own CSF is injected & pt lies in 10 ’ head down position for some time dye ca be detected intranasally with the help of endoscope……….appears bright yellow but when seen with blue filter } flurescent green • Localise the lesion • CT cisternogram • Localise the lesion • Intrathecal injection of iohexol & CT • Where B2 transferrin can’t be done