What is liquorrhea

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What is liquorrhea and why does cerebrospinal fluid leak?

Liquororrhea is the uncontrolled leakage of cerebrospinal fluid (CSF, cerebrospinal fluid).

Cerebrospinal fluid provides stable intracranial pressure, serves as protection against mechanical stress, supports water and electrolyte regulation, and serves to ensure the metabolic process between the brain and blood.

Table of contents:

Cerebrospinal fluid is produced in the brain. The usual location of cerebrospinal fluid is the area between the bones of the spine and the spinal cord, the central canal of the spinal cord, the ventricles of the brain, the area between the bones of the skull and the meninges, the sulci of the brain, and the subarachnoid space.

The leakage of cerebrospinal fluid occurs as a result of a violation of the integrity of the dura mater, as a consequence of injuries to the spine, skull, and after surgical interventions.

What causes the problem

The main factor influencing the development of liquorrhea is injuries or defects of the dura mater. Damage occurs due to:

  • traumatic brain injuries in which the bones of the base of the skull are damaged (pyramid of the temporal bone, bottom of the anterior cranial fossa);
  • traumatic brain injuries in which the bones of the cranial vault (frontal sinus) are damaged
  • neurosurgical intervention in the spine, spinal cord or brain (cerebrospinal fluid leaks through postoperative sutures)
  • growth of pathological neoplasms located in the brain area;
  • congenital anomalies of the central nervous system (hernia in the spinal cord or brain);
  • congenital or acquired anatomical defects of the skull (defect in the sphenoid sinus, ethmoid bone, cribriform plates, posterior wall of the frontal sinus, pyramid of the temporal bone, posterior and middle cranial fossa, roof of the tympanic cavity);
  • injuries of the ethmoid bone sinuses as a result of ENT manipulations (drainage, lavage, removal of foreign objects, removal of polyps);
  • connective tissue diseases (Marfan syndrome), which cause significant thinning of the dura mater of the brain and joint hypermobility;
  • pathological processes in the brain and bones of the skull (disembryogenetic, tumor, inflammatory origin).

Ear liquorrhea in children is caused by a congenital malformation of the labyrinth, which favors the appearance of deafness and meningitis. In adults, it is caused by bulging of the arachnoid mater due to a defect (congenital) in the upper wall of the tympanic cavity or a defect (acquired due to dynamic factors) of the arachnoid mater.

Clinic of the disease

The presence of liquorrhea can be determined by the following symptoms:

  1. Leakage of cerebrospinal fluid (a clear, light-colored liquid, sometimes streaked with blood, or pale pink in color). The flow of cerebrospinal fluid has a periodicity and lasts up to 2 minutes, it can be abundant and scanty, jet and drip. Nasal liquorrhea - occurs from one nostril, and mainly when bending the head forward. Drainage from the ears - occurs when the head is tilted to the side. Leakage from sites of injury to the spine or skull bones (in case of traumatic brain injury, cerebrospinal fluid mixed with blood flows out).
  2. Cough, mainly during sleep, caused by cerebrospinal fluid entering the bronchi and trachea.
  3. Headaches (dull) due to decreased intracranial pressure caused by leakage of cerebrospinal fluid. They can occur with minimal physical activity or when changing body position.
  4. Dehydration occurs when liquorrhea lasts for a long time. Manifests itself in the form of dry skin, mucous membranes, and weight loss.
  5. Decreased sense of smell, vision, hearing.

Forms of violation

This condition can be classified depending on various signs: the form of manifestation, the place of discharge, the cause.

According to the form of manifestation, liquorrhea is divided into obvious (cerebrospinal fluid is released) and hidden (cerebrospinal fluid is not released outward, but is swallowed).

Depending on the cause of development, it can be divided into primary (develops after surgery, trauma) and secondary (occurs after some time due to a cerebrospinal fluid fistula).

Depending on the location of the leakage of cerebrospinal fluid, liquorrhea occurs:

  • spinal – leakage occurs from a defect or injury to the spine;
  • wound (postoperative) – fluid flows out through the postoperative wound;
  • ear – leakage of fluid from the ears (due to a fracture of the temporal bone pyramid);
  • nasal - cerebrospinal fluid is released through the nose (due to injuries to the skull bones).

Diagnostic criteria

Liquororrhea is detected during examination and after research. Diagnostic methods include:

  • taking an anamnesis - helps to determine the time of appearance of the first signs of the condition (leakage of clear fluid); identify actions that could cause the development of the condition (injury, surgery);
  • examination by a neurologist - aimed at detecting defects and injuries of the spine, skull, fracture of the base of the skull, leakage of cerebrospinal fluid from the nose and ears;
  • test for glucose content in liquid (cerebrospinal fluid contains a large amount of glucose);
  • tau protein test (found only in cerebrospinal fluid);
  • computed tomography and magnetic resonance imaging are used - they can identify damage to the skull bones by layer-by-layer studying the structure of the brain;
  • cisternography using radiopaque agents;
  • oil stain test - blot the leaking liquid with a handkerchief (cerebrospinal fluid leaves oil stains, after drying the handkerchief remains soft).

A visit and consultation with a neurosurgeon, otolaryngologist, or traumatologist may also be recommended.

Goals and methods of therapy

Patients with liquorrhea require hospitalization in a neurological or neurosurgical hospital; treatment includes conservative and surgical methods.

Often, the treatment process begins with the use of conservative methods that can reduce the release of cerebrospinal fluid, reduce cerebrospinal fluid pressure, and create conditions for stopping liquorrhea. Non-surgical methods include:

  • preventing tension in the abdominal area, blowing your nose;
  • maintaining the head in an elevated position to stop the release of cerebrospinal fluid;
  • the use of diuretics that reduce intracranial pressure;
  • lumbar drainage - allows you to reduce cerebrospinal fluid pressure in the skull by reducing intracranial pressure;
  • taking antibiotics to treat and prevent infectious diseases;
  • taking non-steroidal anti-inflammatory drugs.

In cases where conservative treatment does not bring a positive result, surgical methods of therapy are resorted to.

Shunt, transcranial and transnasal operations are performed. Endoscopic methods are often used, but they are rarely used for auricular liquorrhea.

Surgical therapy is aimed at surgically eliminating an injury or defect of the skull and dura mater, suturing the wound; removal of a cavity containing cerebrospinal fluid from the brain or spinal cord.

Why is it dangerous?

The danger of liquorrhea lies in possible complications. These consequences include:

  • meningitis - occurs due to infection from the nasal cavity along with cerebrospinal fluid into the brain cavity;
  • headache – due to the leakage of cerebrospinal fluid, intracranial pressure decreases;
  • pneumocephalus - air entering the cerebral membranes, ventricles of the brain, brain matter;
  • pneumonia and bronchitis - due to penetration of cerebrospinal fluid into the respiratory tract;
  • gastritis, dysfunction or inflammation of the intestine - occurs due to the entry and accumulation of cerebrospinal fluid in the stomach.

This section was created to take care of those who need a qualified specialist, without disturbing the usual rhythm of their own lives.

Source: http://neurodoc.ru/bolezni/drugie/likvoreya.html

Liquororrhea

CSF leakage is the leakage of cerebrospinal fluid (CSF). Liquor is a transparent liquid that constantly circulates in the ventricles of the brain, the subarachnoid space of the brain and spinal cord, and the cerebrospinal fluid ducts. Liquor protects the spinal cord and brain from mechanical influences, supports metabolic processes between the blood and the brain, and provides support for constant intracranial pressure.

The main cause of liquorrhea is a violation of the integrity of the dura mater, which can occur in the following situations:

  • damage to the bones of the ethmoid sinus (located deep in the nose) during ENT procedures (drainage, lavage);
  • traumatic brain injury (especially with a fracture of the base of the skull);
  • failure of the sutures of the dura mater after neurosurgical operations;
  • hernias of the brain and spinal cord.

Liquorrhea is accompanied by the following manifestations:

- leakage of cerebrospinal fluid (leakage of cerebrospinal fluid can be observed from the nose, ears, as well as from defects in the bones of the spine or skull);

- headache (caused by a decrease in intracranial pressure due to the leakage of cerebrospinal fluid);

In some cases, there is a leakage of cerebrospinal fluid mixed with blood. This occurs when liquorrhea is a consequence of traumatic brain injury.

During the examination, the doctor specifies what event preceded the appearance of liquorrhea (for example, neurosurgery, traumatic brain injury). A patient with liquorrhea must undergo a neurological examination: the presence of defects in the spine, skull, leakage of cerebrospinal fluid from the nose or ears is determined, and signs of a fracture of the base of the skull are determined.

The patient may have a computed tomography (CT) scan to determine if there is damage to the skull bones. Also in modern times, KT cisternography with radiopaque agents is used.

It is customary to distinguish between obvious and hidden liquorrhea. With obvious cerebrospinal fluid leakage, cerebrospinal fluid is released from the ears and nose outward, saturating the bandage on the patient’s head. In the case of hidden liquorrhea, the release of cerebrospinal fluid goes unnoticed. This situation can occur, for example, when the base of the skull is damaged, when cerebrospinal fluid penetrates into the nasal passages and from there is swallowed or aspirated (inhaled) by the patient.

Depending on the location of the leakage of cerebrospinal fluid, the following types of liquorrhea are distinguished:

  • ear – cerebrospinal fluid leaks from the ears;
  • nasal - cerebrospinal fluid leaks from the nose;
  • wound - cerebrospinal fluid leaks from a postoperative wound;
  • spinal - observed with penetrating injury to the spine, after surgical operations on it or with congenital defects.

Depending on the cause of occurrence, there are:

  • primary liquorrhea - develops immediately after surgery or injury;
  • secondary liquorrhea - appears after a certain period of time due to the formation of a fistula.

If liquorrhea occurs, you should immediately consult a doctor.

If liquorrhea occurs, you should avoid blowing your nose and straining. The patient needs to ensure an elevated position of the head.

The patient may be given diuretics (diuretics) to reduce intracranial pressure, which will lead to a decrease in the leakage of cerebrospinal fluid.

In case of liquorrhea, in order to prevent infection, the patient must use antibacterial drugs.

Surgical methods of treatment for liquorrhea include surgical treatment of the defect of the skull and dura mater, hermetically sealing the wound.

Complications of liquorrhea include:

- the occurrence of severe headaches as a result of decreased intracranial pressure due to the leakage of cerebrospinal fluid;

- development of meningitis (inflammation of the membranes of the brain) due to infection penetration through a defect in the skull and dura mater.

Prevention of liquorrhea includes:

— conducting a thorough examination of a patient who has suffered a traumatic brain injury, as well as timely performance of surgery if necessary;

— timely treatment for congenital defects that can lead to liquorrhea (for example, congenital defects of the base of the skull);

— careful suturing of the dural defect during neurosurgical operations;

— correct performance of otorhinolaryngological manipulations.

Associated symptoms:

Nervous system diseases:

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Spontaneous liquorrhea

Content

Spontaneous cranial liquorrhea

Spontaneous liquorrhea is the leakage of cerebrospinal fluid (CSF) from congenital or resulting from various non-traumatic causes of defects that form in the bones of the skull and dura mater.

The flow of cerebrospinal fluid (CSF) can be constant or periodic, drip or jet. Intensification of liquorrhea is possible when changing the position of the head or straining. Sometimes spontaneous liquorrhea is hidden. With hidden spontaneous liquorrhea, cerebrospinal fluid (CSF) flows into the nasopharynx or is absorbed by the subcutaneous tissue.

Spontaneous liquorrhea accounts for about 20% of all cases of liquorrhea. There are several types of spontaneous liquorrhea depending on the location of the outflow of cerebrospinal fluid (CSF) from the cranial cavity:

  • nasal liquorrhea (most common form)
  • auricular liquorrhea
  • orbital (very rare form)

Spontaneous liquorrhea is divided according to its origin:

  • primary (idiopathic) spontaneous liquorrhea - a clear cause cannot be established
  • secondary spontaneous liquorrhea - a certain pathology leads to the formation of a liquor fistula

Causes and mechanisms of spontaneous liquorrhea

Nasal spontaneous liquorrhea

Most often, a congenital or acquired defect of the bones of the base of the skull (anterior cranial fossa) with spontaneous nasal liquorrhea is localized in the following formations:

  • sphenoid sinus (43%)
  • ethmoid bone (29%)
  • cribriform plate (29%)

Less commonly, the skull base defect is located in the posterior wall of the frontal sinus. Even less commonly, a cerebrospinal fluid fistula may be located in the pyramid of the temporal bone. In this case, the cerebrospinal fluid (CSF) enters first into the middle ear cavity, and then through the auditory tube into the nasopharynx and nasal cavity.

Ear spontaneous liquorrhea

With auricular spontaneous liquorrhea, the integrity of the tympanic membrane is disrupted and the bone defect is localized in the roof of the tympanic cavity (middle or posterior cranial fossa).

Predisposing factors for the occurrence of spontaneous liquorrhea:

  • obesity
  • congenital defects of the skull base (cribiform plate, ethmoidal, sphenoid and frontal sinuses)
  • wide cells (hyperpneumatization) of the sphenoid sinus
  • empty sella turcica

The localization of spontaneous liquorrhea in the lateral part of the sphenoid bone, as well as large defects in the bones of the base of the skull, increase the likelihood of a recurrent form of spontaneous liquorrhea in the patient.

Spontaneous liquorrhea may be based on a connective tissue disease, for example, Marfan syndrome, in which thinning of the dura mater, joint hypermobility, increased skin elasticity, and retinal detachment are observed. The cause of spontaneous liquorrhea can also be pathological processes in the brain and bones of the skull (inflammatory, tumor or dysembryogenetic origin). A number of authors believe that with spontaneous liquorrhea, intracranial pressure constantly or periodically increases in patients, which prevents the independent closure of the dural defect (fistula). Other authors suggest the development of local tissue resorption in the region of the anterior parts of the skull base with normal intracranial pressure.

Most often, a defect in the dura mater (CSF fistula) is formed in the arachnoid and dura maters, closely associated with the olfactory filaments that pass through the thin cribriform plate. Here, birth defects that form in the embryonic period are often possible.

Ear spontaneous liquorrhea has age-related differences. In children, the cause is a congenital malformation of the labyrinth, which contributes to the occurrence of recurrent meningitis and deafness. In adults, the causes of spontaneous liquorrhea may be protrusion of the arachnoid membrane through a congenital defect of the roof of the tympanic cavity, or an acquired defect of the arachnoid membrane due to dynamic factors (increased intracranial pressure). Defects in the roof of the tympanic cavity are often multiple.

Orbital spontaneous liquorrhea

The occurrence of orbital spontaneous liquorrhea is associated with repeated inflammatory processes in the frontal sinuses (chronic frontal sinusitis). The pathological process with orbital spontaneous liquorrhea involves the patient's orbit of the eyeball and the anterior cranial fossa.

Spontaneous liquorrhea occurs more often in obese women (94%). The average age of patients with spontaneous liquorrhea is 49.6 years, and the body mass index is 35.9 kg/m2.

Clinical manifestations and symptoms of spontaneous liquorrhea

Spontaneous liquorrhea is characterized by headaches when changing body position (orthostatic headaches). This may be due to decreased intracranial pressure (intracranial hypotension). Cases have been described in which headaches in patients with spontaneous liquorrhea appear with minimal exertion, and not with changes in body position. Such headaches are anti-orthostatic in nature, which can be explained by an increase in intracranial pressure in the patient.

In the case of prolonged and profuse liquorrhea, the patient may experience signs of general weakening (asthenization) and dehydration (dehydration) in the form of dry skin and visible mucous membranes, as well as weight loss. With hidden and mild liquorrhea, the patient may have no complaints.

With obvious nasal liquorrhea, patients may experience a night cough as a result of cerebrospinal fluid (CSF) entering the trachea and bronchi when the patient lies on his back for a long time. This may lead to the subsequent development of bronchitis.

An important symptom of nasal spontaneous liquorrhea in patients is a violation of the sense of smell in the form of its decrease or reduction (anosmia, hyposmia). Smell impairment occurs more often on one side. Visual impairment indicates damage to the anterior parts of the skull base.

Otorrhea (leakage of cerebrospinal fluid from the ear) is characterized by deafness or hearing loss. Hearing loss is directly proportional to the intensity of liquorrhea, since cerebrospinal fluid (CSF) communicates with the perilymph through the cochlear aqueduct.

Other serious complications of liquorrhea include bronchitis and bronchopneumonia as a result of cerebrospinal fluid (CSF) leaking into the airways. If cerebrospinal fluid (CSF) accumulates in large quantities in the patient's stomach, gastritis may occur.

The danger of serious intra- and extracranial complications necessitates timely diagnosis and choice of treatment tactics for spontaneous liquorrhea. Spontaneous liquorrhea is a life-threatening disease for the patient due to the threat of infection of the cerebrospinal fluid system (purulent meningitis) due to communication between the cranial cavity and the external environment.

Diagnosis of spontaneous liquorrhea

If the patient has a history of an episode of non-meningococcal meningitis, especially of a recurrent nature, this may indicate that he has liquorrhea.

Diagnosing a patient with obvious liquorrhea does not present much difficulty for the doctor. With nasal spontaneous liquorrhea, after tilting the head down, a clear, light liquid begins to drip from one half of the nose. It is possible to distinguish nasal discharge in a patient with liquorrhea from vasomotor and allergic rhinitis by determining the level of glucose in the fluid discharged from the nose. In the cerebrospinal fluid it is significantly higher than in the discharge during rhinitis. When a napkin or handkerchief is moistened with liquor, the latter dries without hardening, unlike discharge from rhinitis. An alternative method for the differential diagnosis of spontaneous liquorrhea has also been developed. It consists of analyzing the products of two-dimensional electrophoresis of nasal discharge. If there is a slight or periodic leakage of cerebrospinal fluid in a patient, the diagnosis of spontaneous liquorrhea becomes difficult.

Depending on the causes (etiology), clinical manifestations, symptoms and capabilities of the medical institution, the following methods are used to recognize spontaneous liquorrhea in a patient:

  • β-2-transferrin test
  • endoscopic examination
  • radioisotope diagnostic methods
  • dye tests
  • X-ray diagnostic methods - MRI, CT, radiography of the skull bones with contrasting cerebrospinal fluid

Endoscopic examination of the nasal cavity most often serves to visually determine the emanating cerebrospinal fluid (CSF) and/or the place of its discharge. Endoscopic examination of the nasal cavity in blue light is even more effective. When a patient has a long-term nasal liquorrhea, in some cases it is possible to detect atrophic changes in the mucous membrane with thinning and maceration of the integumentary epithelium.

The radioisotope method is sensitive enough to diagnose liquorrhea in general, but not for localizing a cerebrospinal fluid fistula. Tests with dyes—indigo carmine, fluorescent substances, and methylene blue—are also used.

Determination of the β-2 fraction of transferrin (tau protein) in nasal discharge is currently the gold standard for confirming the diagnosis of spontaneous liquorrhea. The β-2 fraction of transferrin (tau protein) is a specific protein that is found only in the cerebrospinal fluid.

Magnetic resonance imaging (MRI) of the brain and its liquor cisterns (cisternography) is performed to diagnose spontaneous liquorrhea.

To clarify the location of the fistula tract in the patient, modern radiation diagnostic methods are used:

The effectiveness and sensitivity of CT cisternography in diagnosing spontaneous liquorrhea reaches 71-87%. If CT tomography accurately determines damage to the base of the skull, then with a clear clinical picture of spontaneous liquorrhea, there is no need for other diagnostic methods.

MRI is superior to CT in recognizing encephalocele, a hernial protrusion into the lumen of a skull defect. But MRI is less good at detecting bone damage to the base of the skull. The effectiveness and sensitivity of MRI cisternography for spontaneous liquorrhea reaches 78%. The sensitivity of the combination of MRI methods: spin echo (SE) T1W1 in axial and sagittal projections, SE T2W1 in axial and coronal projections, FLAIR is 100% for spontaneous liquorrhea.

Treatment of spontaneous liquorrhea

Treatment of spontaneous liquorrhea in a patient begins with conservative therapy. Conservative treatment of spontaneous liquorrhea in a patient will be aimed at:

  • decreased secretion of cerebrospinal fluid,
  • decrease in liquor pressure
  • creating favorable conditions for stopping liquorrhea.

If conservative treatment of the patient is ineffective, surgical treatment is used. Surgical treatment of spontaneous liquorrhea, accompanied by liquor hypertension, begins with shunt operations (the application of a lumboperitoneal shunt). If shunting of the cerebrospinal fluid does not have an effect, transcranial and transnasal operations are resorted to.

During transcranial surgery for spontaneous liquorrhea, osteoplastic craniotomy is performed. Then the cerebrospinal fluid fistula is repaired using epidural or subdural access, depending on its location.

During transnasal surgery, plastic closure of the cerebrospinal fluid fistula is performed from the side of the nasal cavity under the control of a rhinological endoscope or microscope.

When the skull base defect is localized in the area of ​​the cribriform plate and sphenoid sinus, transnasal endoscopic methods are more often used to close it. Transnasal endoscopic methods are the most effective, minimally invasive and less traumatic compared to intracranial interventions. Limitations for the use of the surgical technique of transnasal endoscopic access are:

  • localization of the fistula within the posterior wall of the frontal sinus, pyramid of the temporal bone
  • the size of the skull defect is more than 15 mm
  • defects of other localization that are inaccessible to the endoscope
  • inability to determine the location of the fistula before surgery

The traditional transcranial approach provides an excellent view to the neurosurgeon. The disadvantage of this method of operation is the inevitable traction of the frontal lobes of the brain with possible rupture of the olfactory filaments (anosmia or hyposmia after surgery up to 100%) and prolonged hospitalization of the patient.

Endoscopic methods, as a rule, are not applicable in the surgical treatment of auricular liquorrhea, since the defect of the bone or dura mater is inaccessible to the endoscope.

For auricular liquorrhea, transmastoid access (through the mastoid process) is used to close defects in the roof of the tympanic cavity (the most common location of the defect). A common complication of the transmastoid approach is hearing loss. In case of detection of multiple defects in the roof of the tympanic cavity, it is recommended to use access to the middle cranial fossa or its combination with a transmastoid approach. To close defects in the dura mater in the posterior cranial fossa, it is also possible to use a transmastoid approach.

To close defects in the bones of the base of the skull, depending on the access, various tissues are used (periosteum, fascia lata, adipose tissue, cartilage of the nasal septum), adhesive compositions (Tissucol, Tachocomb), as well as their combinations.

Outcomes and consequences of surgical treatment of spontaneous liquorrhea

The recovery of patients after extracranial operations (transnasal endoscopic method) occurs faster than after intracranial interventions.

An unsuccessful outcome of endoscopic surgery for a cerebrospinal fluid fistula may be associated with:

  • with inaccurate localization of liquorrhea
  • presence of multiple fistulas
  • graft displacement
  • unsuccessful comparison of the graft and the dura mater
  • poor healing of the wound surface
  • associated infection
  • increased intracranial pressure

The likelihood of relapse, compared to other types of liquorrhea, is higher. Recurrences of spontaneous liquorrhea after endonasal operations are 3-14%, and after transcranial operations - 10-27%. If a patient experiences recurrent spontaneous liquorrhea, it requires repeated surgical intervention.

Source: http://www.minclinic.ru/cns/spontannaya_likvoreya.html

Liquororrhea

Symptoms of liquorrhea

  • Leakage of cerebrospinal fluid (cerebrospinal fluid that provides nutrition and metabolism in the brain, resembling a clear oily liquid):
    • from the nose, and a person may consider it nasal mucus. Liquor flows predominantly from one half of the nose, most actively when tilting the head forward;
    • from the ears, especially when tilting the head to the sides;
    • from defects in the bones of the skull or spine.

    Sometimes there is a leakage of cerebrospinal fluid mixed with blood when liquorrhea is a consequence of a traumatic brain injury.

  • Dull headache: associated with a decrease in cerebrospinal fluid pressure in the skull.
  • Cough: occurs when cerebrospinal fluid leaks into the airways (most often during sleep).

    • Forms

    • Depending on the manifestations, there are two forms of liquorrhea:
      • obvious - cerebrospinal fluid (cerebrospinal fluid that provides nutrition and metabolism in the brain) is released from the nose and ears;
      • hidden (nasal) - the phenomenon of liquorrhea is hidden, since the liquor is constantly swallowed and cannot be detected.
    • Depending on the location of the leakage of cerebrospinal fluid, the following forms of liquorrhea are distinguished:
      • nasal - cerebrospinal fluid leaks from the nose (associated with damage to the bones of the skull in the area of ​​the anterior cranial fossa, most often in the ethmoid sinus);
      • ear - cerebrospinal fluid leaks from the ears (associated with a fracture of the temporal bone pyramid);
      • wound - cerebrospinal fluid leaks from a postoperative wound;
      • spinal - cerebrospinal fluid leaks from a spinal defect (for example, with back injuries).
    • Depending on the cause of liquorrhea, there are two forms:
      • primary liquorrhea - occurs immediately after injury or surgery;
      • secondary liquorrhea - occurs over a period of time as a result of the formation of a fistula (a passage between the space around the brain and the skin).

    Causes

    • The main reason is a violation of the integrity of the dura mater in combination with a fracture or damage to the bones of the skull/spine.

    May develop in the following situations:

    • traumatic brain injury (penetrating, especially fracture of the base of the skull in car accidents, gunshot wounds).
    • incompetent sutures of the dura mater after neurosurgical operations;
    • damage to the bones of the ethmoid sinus (located deep in the nose) during ENT manipulations (washing, drainage);
    • hernias of the spinal cord and brain.

    A neurologist will help in treating the disease

    Diagnostics

    • Analysis of complaints and medical history:
      • how long ago did the first signs of leakage of cerebrospinal fluid—cerebrospinal fluid, which provides nutrition and metabolism in the brain—appear (constant leakage of clear fluid from the nose and ears);
      • what event immediately preceded the appearance of liquorrhea (traumatic brain injury, head surgery).
    • Neurological examination: presence of defects of the skull, spine, leakage of cerebrospinal fluid from the ears or nose, signs of a fracture of the base of the skull (hemorrhages on the back of the head, around the eyes).
    • Determination of the glucose content in the flowing fluid: there is a lot of glucose in the cerebrospinal fluid, little in the nasal mucus (allows you to distinguish liquorrhea from a runny nose).
    • Handkerchief test (oil stain): wipe off the leaking liquid with a handkerchief. Liquor, unlike nasal mucus, leaves oily stains on the tissue of the handkerchief, and when the handkerchief with liquor dries, it remains soft (while nasal mucus dries out and “hardens”).
    • CT (computed tomography) and MRI (magnetic resonance imaging) of the head and paranasal sinuses: allows you to study the structure of the brain layer by layer and determine the presence of damage to the bones of the skull.
    • It is also possible to consult a traumatologist, otolaryngologist, or neurosurgeon.

    Treatment of liquorrhea

    • Non-surgical methods:
      • avoid straining the abdomen and blowing your nose;
      • elevated position of the head (preventing the leakage of cerebrospinal fluid (cerebrospinal fluid that provides nutrition and metabolism in the brain));
      • diuretics (to reduce intracranial pressure, which will reduce the leakage of cerebrospinal fluid);
      • lumbar drains: release of cerebrospinal fluid from the cavities of the brain to reduce cerebrospinal fluid pressure in the skull;
      • antibiotics (prevention and treatment of infection);
      • anti-inflammatory drugs (non-steroidal anti-inflammatory drugs).
    • Surgical methods:
      • surgical treatment of the defect of the dura mater and skull, hermetically suturing the wound;
      • removal of a cyst (cavity with fluid) of the spinal cord or brain, suturing of a defect in the dura mater.

    Complications and consequences

    • Meningitis: inflammation of the lining of the brain due to infection in the cerebrospinal fluid (cerebrospinal fluid that provides nutrition and metabolism to the brain).
    • Severe headaches due to decreased cerebrospinal fluid pressure in the cranial cavity.

    Prevention of liquorrhea

    • A thorough examination of the head wound and timely surgical treatment for traumatic brain injuries.
    • Careful suturing of the dural defect after neurosurgical operations.
    • Sources

    A.S.Nikiforov, E.I.Gusev - General neurology, 2007

    MB Allen, RH Miller - Essentials of Neurosurgery, 1994

    Mark S. Greenberg - Handbook of Neurosurgery, 2005

    What to do with liquorrhea?

    • Choose a suitable neurologist
    • Get tested
    • Get a treatment plan from your doctor
    • Follow all recommendations

    Do you have liquorrhea?

    the neurologist will prescribe the correct treatment for liquorrhea

    Source: http://lookmedbook.ru/disease/likvoreya

    Liquor: what is it?

    Liquor is a fluid directly from the cerebrospinal fluid. This fluid is extremely important; it helps ensure normal functioning of the brain. Additionally, it should be noted that there is also nasal liquorrhea, this is the leakage of cerebrospinal fluid from the nasal cavity, this can occur due to injury to the skull.

    Causes of nasal liquorrhea

    Liquororrhea from the nose can occur not only when the skull is damaged. Doctors also identify other reasons.

    • If a person has had a severe back injury that damaged the spine.
    • When removing polyps or any foreign object from the nasal cavity. This phenomenon usually arises from a number of complications.
    • With anatomical deformation of the skull, but not acquired, but congenital.
    • If a person has a hernia, for example in the spinal cord or brain.
    • Also, among the main causes of nasal liquorrhea, poor-quality neurosurgical manipulations are noted.

    It is worth noting that this phenomenon can also be spontaneous. This means that nasal liquorrhea does not arise from the reasons listed above. In this case, before starting treatment, it is necessary to conduct a thorough diagnosis to establish the true cause.

    Clinical picture

    1. The most basic sign that a person needs to pay attention to is nasal discharge. In this case, the person will leak not just mucus, but an oily liquid.
    2. In addition, the patient begins to suffer from a headache, which is dull in nature. It can occur at any time of the day. Headache with this problem occurs due to the fact that intravenous pressure, namely cerebrospinal fluid pressure, decreases.
    3. Pay special attention! If, during this course, the patient’s fluid enters the respiratory tract, the patient develops a lightning-fast cough. Such a cough can torment the patient at night, since at this time he is in a horizontal position.

    These are the main symptoms by which nasal liquorrhea can be recognized.

    How is the treatment carried out?

    Before prescribing therapy, it is necessary to conduct a diagnosis. Therefore, in a laboratory setting, a little liquid is taken from the patient. Then an analysis is carried out for glucose levels.

    How to recognize liquorrhea at home? At home, you can quickly recognize this phenomenon. You just need to blow your nose well into a handkerchief. If oily liquid remains on it, then you need to urgently consult a doctor.

    To determine the causes of nasal liquorrhea, doctors can use only two methods. The first method is to send the patient for a magnetic resonance examination, and the second method is to conduct a CT scan (computed tomography).

    Treatment

    Among non-surgical methods, doctors recommend that the patient avoid straining the abdomen. Also, don't blow your nose often. If cerebrospinal fluid begins to leak from the nasal cavity, it is necessary to raise the head, as if bleeding.

    In addition, the patient is also prescribed diuretics. They are necessary in order to reduce intracranial pressure as quickly as possible. If the pressure returns to normal, then fluid will stop flowing from the nasal cavity.

    In case of severe leakage, medications from a number of antibiotics are prescribed. They help not only normalize the body’s condition, but also cure existing infections. Anti-inflammatory drugs are also prescribed as part of complex treatment.

    The surgical treatment method involves treating the defect directly on the dura mater. In addition, doctors perform hermetically sealed suturing of the patient’s wounds.

    If a cyst is detected during examination in a patient, it must be removed as soon as possible. This can be done using a laser procedure or liquid nitrogen.

    In addition, for nasal liquorrhea, surgical treatment can be used as treatment. Two different surgical operations can be performed, everything will depend on the severity, causes and general condition of the patient. Also, attention is paid to the medical history; it is necessary to “cross out” contraindications to surgical intervention.

    • transcranial;
    • endoscopic endonasal procedure.

    The doctor in the neurological or neurosurgical department will be able to tell you which surgical method will be used.

    Remember, if measures are not taken in time, serious complications may arise that will aggravate the person’s condition. Complications include: meningitis, gastritis or pyelonephritis.

    Therefore, if you detect oily fluid from the nasal cavity, you need to go to the doctor as soon as possible. After all, only he will be able to conduct a thorough diagnosis and prescribe the necessary treatment.

    Source: http://gaimoritstop.ru/likvor-chto-eto-takoe.html

    Liquororrhea

    1. Small medical encyclopedia. — M.: Medical encyclopedia. 1991–96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. — 1982—1984

    See what “Liquor rhea” is in other dictionaries:

    Liquororrhea - leakage of cerebrospinal fluid (CSF) from the nose, ear, wound openings and other defects of the skull or spine associated with damage to the dura mater. The leaking liquid is usually transparent and colorless, but it can be ... Encyclopedic Dictionary of Psychology and Pedagogy

    liquorrhea - (liquorrhoea; cerebrospinal fluid + Greek rhoia outflow) outflow of cerebrospinal fluid through a defect in the dura mater ... Big medical dictionary

    Liquorrhea - (liquorrhoea; lat. liquor liquid + Greek. rhoia outflow) outflow of cerebrospinal fluid (CSF) from natural or formed for various reasons holes in the bones of the skull or spine, which occurs when the integrity of ... ... Wikipedia

    Nasal liquorrhea - see Nasal liquorrhea ... Big Medical Dictionary

    nasal liquorrhea - (l. nasalis; synonym L. nasal) L. into the nasal cavity through a defect in the dura mater in the area of ​​the ethmoid bone plate or at the site of a fracture of the sphenoid bone ... Big Medical Dictionary

    postoperative liquorrhea - (l. postoperativa) L. from the operating room: wounds of the skull or spine; occurs when the sutures are insufficient. or for inflammatory complications of surgery ... Big Medical Dictionary

    hidden liquorrhea - (l. occulta) L. in tissues and closed body cavities ... Big Medical Dictionary

    auricular liquorrhea - (l. auralis) L. from the external auditory canal (usually with a fracture of the temporal bone pyramid) ... Big medical dictionary

    Chronic liquorrhea - The leakage of cerebrospinal fluid from the nose (rhinorrhea) or from the ear (otorrhea), which manifests itself after the healing of the integumentary tissues of the head in a person who has suffered an open penetrating craniocerebral injury (see). It is a sign of a fracture of the base of the skull. At the same time, rhinorrhea ... ... Encyclopedic Dictionary of Psychology and Pedagogy

    The brain is the anterior part of the central nervous system, located in the cranial cavity. Embryology and anatomy In a four-week human embryo, 3 primary brain vesicles appear in the head part of the neural tube, anterior... ... Medical encyclopedia

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    Source: http://dic.academic.ru/dic.nsf/enc_medicine/16524/%D0%9B%D0%B8%D0%BA%D0%B2%D0%BE%D1%80%D0%B5%D1 %8F

    Nasal liquorrhea

    Nasal liquorrhea is the leakage of cerebrospinal fluid from the nasal cavity caused by damage to the skull.

    Liquor is cerebrospinal fluid that is extremely important for the normal functioning of the brain. In appearance it is a clear watery liquid. The danger is that many people may think that water or normal mucous discharge is coming from the nose and not give this situation any serious significance. Often it can be diluted with blood, which is quite natural, taking into account the traumatic component of this process.

    In its normal state, cerebrospinal fluid is located between the brain and the bone tissue of the skull. In addition, cerebrospinal fluid is located in the cavities of the brain. However, if the integrity of the skull is violated, all conditions are created for the development of nasal liquorrhea.

    The nasal cavity is separated from the intracranial cavity by the paranasal sinuses. When cerebrospinal fluid flows out, it initially fills one of the paranasal sinuses. Usually sphenoid, frontal or ethmoidal labyrinth. After which, from the corresponding paranasal sinus it flows directly into the nasal cavity. Then there are two options. The fluid may pour out through the nostrils or penetrate through the nasopharynx into the esophagus.

    Most often, cerebrospinal fluid leaks from only one nostril. Its release is especially active when the head is tilted. Also, the pathological condition in question can be confused with rhinorrhea.

    Nasal liquorrhea can occur immediately after a person receives a traumatic brain injury, or it can appear only after some, sometimes quite long, time.

    In addition to the nasal form, liquorrhea can also have an ear form. In this case, clear liquid comes out through the ear.

    In addition, cerebrospinal fluid fills the space between the spinal cord and the bone tissue of the spinal column. In case of back injuries, it can be released at the site of its localization.

    Causes

    In the vast majority of cases, the cause of nasal liquorrhea is traumatic brain injury. In addition, it can be called:

    • spinal injuries due to back injuries;
    • surgery to remove nasal polyps;
    • congenital anatomical defects of the skull;
    • surgery to remove a foreign object from the nose;
    • the presence of herniations of the spinal cord or brain;
    • damage to the bone structures of the ethmoid labyrinth;
    • poorly performed neurosurgical surgery.

    In addition, liquorrhea can be spontaneous. That is, it arises in a situation where none of the above reasons simply exist.

    Symptoms

    The main sign indicating the development of nasal liquorrhea is the flow of clear oily liquid from the nasal cavity.

    Patients often experience a dull headache. This is explained by a decrease in intracranial cerebrospinal fluid pressure.

    When cerebrospinal fluid enters the respiratory tract, a cough occurs. As a rule, this situation occurs at night, when the person is sleeping and, therefore, his body is in a horizontal lying position.

    Diagnostics

    It is not difficult to detect liquorrhea. This is achieved through a medical examination and medical history.

    A sample of the oozing clear fluid is also taken. In laboratory conditions, it is analyzed for glucose content.

    There is also a method for self-diagnosis of nasal liquorrhea. Blot the leaking liquid with a handkerchief. The liquor leaves oil stains on the handkerchief. If it is simple watery snot, then nothing of the kind will be noted.

    To detect the specific location of bone tissue damage, magnetic resonance or computed tomography techniques are used.

    Complications

    Leakage of cerebrospinal fluid is primarily dangerous due to the possibility of complications. These include the following serious diseases:

    That is why, at the first suspicion of liquorrhea, it is necessary to immediately contact a medical institution and undergo the necessary examination.

    Treatment

    There are conservative and surgical methods for treating this pathological condition.

    It should also be remembered that a patient suffering from liquorrhea needs complete rest. Bed rest is advisable. You should lie on high pillows. This will ensure an elevated position of the head and prevent the leakage of cerebrospinal fluid. You should not strain, blow your nose or sneeze.

    Conservative therapy

    For nasal liquorrhea, it includes the following measures:

    • the use of antibiotics and anti-inflammatory drugs to prevent the occurrence of infectious complications;
    • taking diuretic medications;
    • carrying out lumbar drainages.

    Surgical interventions

    Such methods are used only in cases where conservative treatment has not brought positive results.

    There are several types of possible operations:

    • transcranial;
    • endoscopic endonasal;
    • shunting

    The specific method of therapy is determined solely by the doctor.

    This is a very dangerous disease. I had encephalitis - everything was associated with trauma to the nasopharynx. It all came from angiofibroma of the nasopharynx. Be vigilant.

    All materials are for informational purposes only.

    Before using the information received, consult your doctor.

    Questions and suggestions:

    Copying of materials is permitted only with an active link to the source.

    Source: http://rinitanet.ru/obschie-voprosi/nazalnaya-likvoreya.html

    What is liquorrhea?

    Liquororrhea is a condition that occurs when the dura mater is damaged and there is a loss of cerebrospinal fluid (CSF). As a rule, the leaking liquid is transparent and colorless, but with inflammation it may become cloudy. The loss of cerebrospinal fluid can occur completely unnoticed by the patient, while it flows into the nasopharynx or soaks into the subcutaneous tissue. The danger of this condition is that such stains can become infected, which leads to the development of meningitis, encephalitis, myelitis and other inflammatory processes.

    Basic information

    A lot has been written about what liquorrhea is and why it occurs. Let's understand the basic concepts that are present in this symptom. Leakage of cerebrospinal fluid can have several causes. The most common of them are:

    1. Traumatic brain injury, when there is damage to the bones of the skull, for example, the temporal bone or the anterior cranial fossa. This condition is called post-traumatic basal liquorrhea.
    2. Neurosurgical operations.
    3. Growing tumors at the base of the skull.
    4. Malformations of the central nervous system, for example, the presence of spina bifida or cranial hernia.

    Based on localization, liquorrhea can also be divided into several types. The most common is what is called nasal or nasal. In second place in frequency is the ear leakage of cerebrospinal fluid. In third place is the loss of cerebrospinal fluid from the postoperative wound, even though it is sutured. And finally, the least common is oculorrhea, that is, cerebrospinal fluid leaks from the eyes in the form of tear fluid.

    In this case, the outflow can be constant or periodic. Periodic liquorrhea occurs only when the body position changes. Based on the amount of liquid flowing out, it can be divided into drip and jet.

    Manifestations

    Sometimes a fairly long period passes from the moment of injury to the appearance of cerebrospinal fluid leakage. This is especially true for nasal liquorrhea, the symptoms of which are difficult to confuse with other diseases. However, in some cases, this condition may not occur due to injury, but after some kind of surgical intervention, for example, removal of a polyp. And sometimes it is impossible to find out the reasons for the loss of cerebrospinal fluid - this is called spontaneous liquorrhea.

    The main symptom is a light, clear fluid draining from the nose, but in some cases it may be streaked with blood or a pale pink color. This most often occurs from one nostril and when the head is tilted forward. At the same time, other symptoms may appear, such as a night cough.

    Of course, the constant flow of fluid from the nose is not a pleasant phenomenon. This can severely limit a person's physical or social activities. However, few people know that the main danger of this condition is complications. And first of all, you should think about the development of meningitis, which occurs when the inflammatory process moves from the nasal cavity to the cranial cavity. At the same time, the intensity of brain inflammation also depends on the duration of the outflow of cerebral fluid. Meningitis can lead to the death of the patient.

    The second, no less dangerous complication of nasal livorrhea is pneumocephalus, in which air gets inside the skull. Bronchitis and pneumonia or gastritis also pose a great danger if a large amount of liquid enters the stomach.

    Treatment

    Any manifestations of liquorrhea require hospitalization in a hospital, most often in the neurology department. Here treatment will be carried out according to the symptoms shown. In this case, it is worth starting with conservative therapy. Bed rest is prescribed for 2, and sometimes 3 weeks. In this case, the patient must find a position in which the flow of fluid completely stops. You should also be especially careful when coughing or sneezing, as this will increase intracranial pressure and lead to further leakage of cerebrospinal fluid.

    To prevent infections, antibacterial therapy is carried out, but the drug should be selected only by the attending physician.

    If therapy does not produce results, then surgical treatment is performed using a specially developed method. However, against the background of acute traumatic brain injury, surgery can be performed no earlier than 3 weeks from the moment of injury, of course, if the liquorrhea has not stopped. Before planning an operation, it is necessary to carry out a differential diagnosis with a condition such as rhinorrhea.

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    The information on the site is provided solely for popular informational purposes, does not claim to be reference or medical accuracy, and is not a guide to action. Do not self-medicate. Consult your healthcare provider.

    Source: http://vashaspina.ru/chto-takoe-likvoreya/