Clinical Exploration of Misdiagnosis and Mistreatment for Spontaneous Ce-rebrospinal Fluid Rhinorrhea
LUO Xiao
JIANG Jian
LIU Dongmei
GAO Shan
Abstract：Objective To analyze the causes of clinical misdiagnosis and mistreatment of spontaneous cerebrospinal fluid(CSF)rhinorrhea,and to summarize the measures to avoid misdiagnosis and mistreatment.Methods The clinical data of 11 patients with spontaneous CSF rhinorrhea who were misdiagnosed from December 2008 to August 2023 were retrospec-tively analyzed.Results Eight patients were misdiagnosed as allergic rhinitis due to runny watery nose and pale or reddish nasal mucosa.One patient had translucent lychee fleshy masses in the left nasal passages and middle nasal passages.CT scan of the paranasal sinuses showed"left maxillary sinus,ethmoid sinusitis,and soft tissue density shadow in the left middle nasal passages",which was misdiagnosed as left chronic sinusitis with nasal polyps.One patient was misdiagnosed as acute rhinitis due to head discomfort and watery nose after upper respiratory tract infection.A patient with fluid flowing from the nasal cavity to the larynx during sleep was misdiagnosed as a cyst of the right maxillary sinus after sinus CT showed "ovoid mass of the right maxillary sinus with clear boundary which was considered to be a cyst".After symptomatic treatment,the symptoms of 11 patients were not relieved,and further imaging and quantitative determination of glucose in rhinorrhea were confirmed as spon-taneous CSF rhinorrhea.The misdiagnosis lasted 10-60(24.09±13.5)d.All 11 patients recovered after endoscopic repair of CSF rhinorrhea.Conclusion The onset of spontaneous CSF rhinorrhea is insidious,rare in clinical settings,and mostly unilateral,and the rhinorrhea are mostly persistent,clear and colorless,which can be aggravated by increased intracranial pressure caused by changes in body position,cough,sneezing,and constipation.Sinus CT and magnetic resonance imaging can provide evidence for the diagnosis of this disease,and the final diagnosis requires quantitative determination of glucose in rhinorrhea.
Keywords：Spontaneous cerebrospinal fluid rhinorrheaMisdiagnosisAllergic rhinitisSinusitisNasal polypsMaxillary sinus cystAcute rhinitisRepair of cerebrospinal fluid rhinorrhea
Publication Date：2024-11-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 23-27 )